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Pbm Claims Analyst Jobs in Reston, VA (NOW HIRING)

Lucyrx

Financial Analyst

Bethesda, MD · On-site +1

Bachelor's in Finance, Accounting, Economics, Business, or related field. * 3-5+ years' experience in Finance/FP&A, PBM analytics, or contract/claims analytics. * Strong Excel skills (advanced ...

Surescripts

VP Data Solutions

Arlington, VA · On-site

Own the full lifecycle of data and analytics products - including ideation and market validation ... Background in healthcare data - claims, pharmacy, clinical, or interoperability data * Experience ...

Syra Health

Pharmacist

Washington, DC · On-site

Summarize and analyze switches between MCP PDLs and Fee-for-Service (FFS) PDLs. * Develop ... claims submission and Pharmacy Benefit Management (PBM) experience working with Pyxis or similar ...

All JobsPbm Claims Analyst JobsPbm Claims Analyst Jobs in Reston, VA

Pbm Claims Analyst information

See Reston, VA salary details

$15

$28

$54

How much do pbm claims analyst jobs pay per hour?

As of Jul 30, 2026, the average hourly pay for pbm claims analyst in Reston, VA is $28.50, according to ZipRecruiter salary data. Most workers in this role earn between $21.01 and $32.74 per hour, depending on experience, location, and employer.

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.

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 are the key skills and qualifications needed to thrive as a PBM Claims Analyst, and why are they important?

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 PBM Claims Analysts?

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 popular job titles related to Pbm Claims Analyst jobs in Reston, VA? For Pbm Claims Analyst jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Pbm Claims Analyst jobs in Reston, VA look for? The top searched job categories for Pbm Claims Analyst jobs in Reston, VA are:
What cities near Reston, VA are hiring for Pbm Claims Analyst jobs? Cities near Reston, VA with the most Pbm Claims Analyst job openings:
Pbm Claims Analyst jobs near you

Financial Analyst

Lucyrx

Bethesda, MD • On-site, Remote

Full-time

Re-posted 21 days ago

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

The Financial Analyst will support PBM operations with a focus on rebate analytics, pharmacy network economics, and financial performance insights. This role collaborates with Strategic Solutions & Services, Rebate Management, Network Strategy, and Strategic Data & Analytics to improve transparency, forecasting, and operational decision-making.

Role and Responsibilities:

Rebate Analytics

  • Own rebate forecasting and month-end accruals; reconcile accruals to cash and explain variances.

  • Validate rebate eligibility and detect leakage tied to contract or data issues.

  • Maintain and enhance financial models linking contract terms to realized rebate performance.

Network Analysis

  • Analyze pharmacy network reimbursement trends, guarantee compliance, and preferred network mix.

  • Model financial impact of pricing or network strategy changes and produce scenario analyses.

  • Develop and maintain KPIs for network unit cost, effective rate, mix shifts, and program savings.

Financial Ownership & Performance

  • Support monthly close for PBM financial lines including ingredient cost, admin fees, and rebates.

  • Prepare variance analysis, drivers, and executive-ready reporting.

Data, Reporting & Automation

  • Build repeatable workflows and validations using SQL, Alteryx, and advanced Excel.

  • Improve data quality, documentation, and reporting consistency across systems.

Qualifications and Education Requirements:

  • Bachelor's in Finance, Accounting, Economics, Business, or related field.

  • 3-5+ years' experience in Finance/FP&A, PBM analytics, or contract/claims analytics.

  • Strong Excel skills (advanced formulas, modeling).

  • SQL proficiency for querying large claims datasets.

  • Alteryx experience building automated workflows.

  • Ability to communicate complex analysis clearly to cross-functional partners.

Preferences:

  • Knowledge of PBM pricing components, reimbursement structures, and claim-level data fields.

  • Hands-on experience with rebate programs, accrual methodologies, or cash reconciliation.

  • Exposure to network/contract analytics and guarantee monitoring.

  • Familiarity with SQL-based reporting environments or Python/VBA for automation.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.

What We Do
LucyRx is an independent, next-generation pharmacy benefits manager (PBM) transforming how healthcare works. We're fixing what's broken in the PBM industry by putting people first and challenging outdated norms. For too long, traditional PBMs have prioritized profit over patients, and we believe that's just plain wrong.

LucyRx offers bold, innovative solutions powered by LucyIQ, our proprietary AI platform, to deliver actionable insights that lower costs, improve care, and simplify prescription management.

While we're new to the PBM space, LucyRx is built on decades of leadership experience and a commitment to meaningful change. We're a nimble, remote-first team with a bold mission to redefine pharmacy benefits-and we're just getting started.

What It's Like to Work at LucyRx
At LucyRx, we're a fast-moving team dedicated to making healthcare simpler, fairer, and more effective. Joining us means being part of a dynamic, mission-driven group that works collaboratively to challenge outdated industry practices and redefine what's possible in pharmacy benefits.

We value accountability, innovation, and a relentless focus on making an impact. Here, you'll find a supportive culture that encourages you to bring your whole self to work, share bold ideas, and grow alongside smart, driven colleagues who are passionate about fixing the PBM industry. If you're ready to roll up your sleeves and make a real difference, we'd love to have you on our team.

LucyRx is an independent, next-generation pharmacy benefit manager (PBM) redefining prescription care. Fueled by innovation and decades of leadership experience, LucyRx delivers better outcomes through its integrated specialty network, formulary marketplace, and next-day home delivery solutions.

Powered by its proprietary AI platform, LucyIQ, the company provides real-time insights that support evidence-based clinical decisions, clear pricing, and exceptional service from U.S.-based pharmacy technicians.

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