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Pbm Claims Analyst Jobs (NOW HIRING)

Scriptwellrx

Business Analyst

Mission, KS · On-site

$65 - $90/hr

We're a small, fast-moving healthcare data analytics company looking for a curious, detail-oriented ... Prior exposure to 340B, PBM, claims, or other healthcare/pharmacy data is a plus. What we offer

New

STI

Business Analyst (Healthcare PBM) - Remote

Seeking a Business Analyst with Healthcare/PBM experience to support pharmacy claims implementations through requirements gathering, data analysis, system integration, and testing. Responsibilities

SlateRx

PBM Senior Analyst, Underwriting

Las Vegas, NV · On-site +1

... claims databases. Skilled in utilizing data analysis tools and techniques to identify trends ... Ability to assess and quantify risk factors associated with PBM contracts and pricing strategies.

SlateRx

PBM Senior Analyst, Underwriting

Las Vegas, NV · On-site

... claims databases. Skilled in utilizing data analysis tools and techniques to identify trends ... Ability to assess and quantify risk factors associated with PBM contracts and pricing strategies.

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How much do pbm claims analyst jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for pbm claims analyst in the United States is $27.39, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.49 per hour, depending on experience, location, and employer.

What is a PBM Claims analyst?

PBM Claims Analysts are professionals who review, process, and resolve pharmacy benefit management (PBM) claims. They ensure that prescription drug claims are accurate, comply with insurance policies, and adhere to regulatory guidelines. These analysts often work for health insurers, PBMs, or healthcare organizations, handling claim discrepancies, reconciling payments, and answering questions from pharmacies or patients. Their role is crucial in ensuring that patients receive appropriate prescription benefits and that all transactions are processed efficiently.

What are the key skills and qualifications needed to thrive as a PBM Claims analyst?

To thrive as a PBM Claims Analyst, you need strong analytical abilities, attention to detail, and knowledge of pharmacy benefit management and healthcare claims processes, typically supported by a degree in healthcare, business, or a related field. Familiarity with claims processing systems, pharmacy benefit management software, and proficiency in tools like Excel are commonly required, along with understanding HIPAA regulations. Excellent problem-solving, communication, and organizational skills help in resolving claim discrepancies and collaborating across teams. These competencies are vital for ensuring accurate claims adjudication, maintaining compliance, and supporting the financial integrity of pharmacy benefit programs.

What are some typical challenges faced by a PBM Claims analyst and how can they be managed?

PBM Claims Analysts often face challenges such as navigating complex pharmacy benefit structures, managing large volumes of claims data, and keeping up with frequent changes in healthcare regulations. Staying detail-oriented and developing strong analytical skills are key to accurately processing claims and identifying discrepancies. Collaborating closely with pharmacists, providers, and other team members helps resolve issues efficiently, while ongoing training ensures analysts remain current with industry standards and compliance requirements.

What is the difference between Pbm Claims Analyst vs Pharmacy Claims Processor?

AspectPbm Claims AnalystPharmacy Claims Processor
CredentialsRelevant certifications (e.g., CPC, CPhT), healthcare knowledgeBasic pharmacy technician certification, on-the-job training
Work EnvironmentHealthcare or insurance company offices, call centersPharmacy settings, mail-order pharmacies, retail pharmacies
Employer & IndustryPBMs, health insurance companies, healthcare providersPharmacies, retail chains, mail-order pharmacies
Job FocusClaims analysis, benefit management, data reviewProcessing pharmacy claims, data entry, verifying prescriptions

The main difference is that a Pbm Claims Analyst focuses on analyzing pharmacy benefit claims, managing data, and ensuring benefit accuracy, often requiring healthcare certifications. In contrast, a Pharmacy Claims Processor primarily handles the day-to-day processing of pharmacy claims, with less emphasis on analysis or benefit management.

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Pbm Claims Analyst jobs near you
Infographic showing various Pbm Claims Analyst job openings in the United States as of August 2026, with employment types broken down into 89% Full Time, 6% Part Time, and 5% Contract. Highlights an 82% Physical, 7% Hybrid, and 11% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Jr Claims Analyst

Ruri Software Technologies LLC

Mason, OH • On-site

Full-time

Re-posted 18 days ago

Job description

Job Title:- Jr Claims Analyst
Location:- Job Location:- Mason, OH/Richmond, VA/Norfolk, VA/Atlanta, GA/Thousand Oaks, CA/ Wallingford, CT/ Woodland Hills, CA ( Day 1 Onsite, 3 Days in Office is Must)
Duration:- 8+ months
Description:
Note from the client:- Role will be of a Claims analyst/Jr BA Claims.. Ideal candidates will be 6 months+ experienced resources with health care background or Fresh college graduated who have healthcare background and willing to learn with a good attitude
Client is looking for a Claims Analyst to work with one of the leading healthcare providers in the US as part of UST's PBM Practice.
Responsibilities
As a Pharmacy Benefit Management (PBM) Claims Analyst, you will
• Perform Claim analysis, claims audit
• Perform data analysis, fata comparisons and create summary, trends, and statistics
• Creates and maintains documentation of key team tasks.
• Participate with team members in performing testing and validations
• Identifies and drives process improvements.
Requirements
• Knowledge in Business Analysis
• Knowledge in Healthcare domain
• Strong and clear communication skills - email and during meetings
• Quick learning ability, positive attitude, and good team player
• Experience using Microsoft programs (Word, Excel, and PowerPoint)
• Knowledge in JIRA/Agile methodologies
• Knowledge SQL queries, should be able to query and summarize data

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