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

Interon IT Solutions

GCP Data Engineer

Chantilly, VA · On-site

$117K - $140K/yr

The engineer will work with architects, analysts, product owners, and other engineering teams to ... Preferred Qualifications * Healthcare, pharmacy, PBM, claims, or health insurance experience.

New

Interon IT Solutions

GCP Data Architect

Chantilly, VA · On-site

$65.25 - $84/hr

Design scalable batch, streaming, analytics, and data-sharing architectures. * Establish ... Preferred Qualifications * Healthcare, pharmacy, PBM, claims, or health insurance experience.

New

Clearpath

Senior Political Research Analyst

Arlington, VA · On-site

$90 - $130/hr

You will write, edit, and substantiate claims made in a variety of research documents * Develop and ... PBM ® empowers employees to be entrepreneurial, to innovate, and to continually drive ...

New

Sedgwick Law

Vice President, Clinical Pharmacy

Washington, DC · On-site

$146K - $193K/yr

Provide analysis of claims data and book-of-business metrics, translating trends into actionable ... in PBM management and health care benefit knowledge. Active unrestricted license to practice ...

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 Aug 21, 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 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

Google Cloud Platform Data Engineer

Interon IT Solutions LLC

Chantilly, VA • On-site

$117K - $140K/yr

Other

Posted yesterday

New

Job description

#W2 role

Role: Senior Google Cloud Platform Data Engineer
Location:Remote
Experience: 8+ years

Job Description

Our client is looking for an experienced Google Cloud Platform Data Engineer to build and support cloud-based data solutions for healthcare, pharmacy, claims, member, and operational data.

This is a hands-on development role. The engineer will work with architects, analysts, product owners, and other engineering teams to build reliable batch and real-time data pipelines on Google Cloud Platform.

Responsibilities

  • Design, develop, and maintain scalable data pipelines using Google Cloud Platform services.

  • Build batch and streaming solutions using Dataflow, Pub/Sub, BigQuery, Cloud Storage, Dataproc, and Cloud Composer.

  • Develop data-processing applications using Python, SQL, Spark, and Apache Beam.

  • Create BigQuery tables, views, stored procedures, and data models.

  • Apply partitioning and clustering strategies to improve BigQuery performance and cost.

  • Ingest and transform healthcare, pharmacy, claims, member, provider, and operational data.

  • Build data validation, reconciliation, error-handling, and monitoring processes.

  • Troubleshoot pipeline failures, data-quality issues, and performance problems.

  • Support data migration from legacy and on-premises platforms to Google Cloud Platform.

  • Protect PHI, PII, and other sensitive information using appropriate security and access controls.

  • Develop automated build and deployment pipelines using Git, Jenkins or GitLab CI/CD, and Terraform.

  • Participate in code reviews, production releases, and operational support.

Required Qualifications

  • 8+ years of data engineering or software development experience.

  • 4+ years of hands-on experience with Google Cloud Platform data services.

  • Strong experience with BigQuery, Dataflow, Pub/Sub, Cloud Storage, Dataproc, and Cloud Composer.

  • Advanced Python and SQL development skills.

  • Experience with Spark, Apache Beam, and Airflow.

  • Strong understanding of ETL/ELT, data warehousing, data lakes, and distributed data processing.

  • Experience building both batch and streaming data pipelines.

  • Experience with Docker, Kubernetes, Terraform, Git, and CI/CD.

  • Strong troubleshooting and communication skills.

Preferred Qualifications

  • Healthcare, pharmacy, PBM, claims, or health insurance experience.

  • Understanding of HIPAA, PHI, and PII requirements.

  • Experience with dbt, Dataplex, Data Catalog, Cloud Run, Cloud Functions, or Looker.

  • Google Professional Data Engineer certification.

Apply