1

Pbm Claims Analyst Jobs (NOW HIRING)

The Vendor Auditor analyzes medical, pharmacy, and PBM claims data to assess payment accuracy, performs root cause analysis of identified trends and discrepancies, and reviews vendor compliance with ...

GCP Data Engineer

Chantilly, VA ยท 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.

The Vendor Auditor analyzes medical, pharmacy, and PBM claims data to assess payment accuracy, performs root cause analysis of identified trends and discrepancies, and reviews vendor compliance with ...

$46.99 - $122.40/hr

Collaborating with PBM Sales and Account Services to provide recommendations on pricing and ... Applying advanced Excel modeling techniques to analyze large sets of pharmacy claims data and build ...

$46.99 - $122.40/hr

Collaborating with PBM Sales and Account Services to provide recommendations on pricing and ... Applying advanced Excel modeling techniques to analyze large sets of pharmacy claims data and build ...

GCP Data Architect

Chantilly, VA ยท 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.

NY ยท On-site

$66 - $90/hr

... claims, PBM reports and action items, drug rebates and discounts, Plan to Plan payments, CMS ... collecting, analyzing and reporting identifying measures. Schedules, attends and presents ...

Showing results 21-40

Pbm Claims Analyst information

See salary details

$14

$27

$51

How much do pbm claims analyst jobs pay per hour?

As of Sep 5, 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.

More about Pbm Claims Analyst jobs

What cities are hiring for Pbm Claims Analyst jobs?

Cities with the most Pbm Claims Analyst job openings:

What states have the most Pbm Claims Analyst jobs?

States with the most job openings for Pbm Claims Analyst jobs include:

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.

Associate Pharmacy Benefit Consultant

Rael & Letson

Seattle, WA โ€ข Remote

$120K - $155K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 7 hours ago


Job description

About Us:

Rael & Letson is an independent employee benefits consulting and actuarial services firm. We serve as a trusted advisor to multiemployer and other retirement and health plans, helping bring high quality benefits to working people. We partner with our clients to design, implement, evaluate and communicate innovative and cost-effective benefit programs customized to their unique needs.

Responsibilities:

The Associate Pharmacy Benefit Consultant provides pharmacy benefit oversight and Pharmacy Benefit Management (PBM) industry expertise, including plan design, PBM procurement, claims and pricing audits, contractual review, rebate auditing, and guidance on pharmacy matters such as formulary structure and new drugs to market. The Consultant communicates and resolves pharmacy issues for clients, often in coordination with the Health & Welfare Consultant to the client.

Support pharmacy benefit consulting activities, including:

  • Preparing, conducting, and analyzing PBM RFPs, including specialty carve-out vendors as requested
  • Performing audits of pharmacy benefit management contracts and pharmacy benefits using PBM claims data
  • Participating in and supporting clients’ financial recovery efforts
  • Reviewing PBM pricing, rebates, performance guarantees, plan design, claim eligibility, and other features impacting plan and participant costs
  • Advising clients and colleagues on pharmacy matters, emerging market developments, formulary structure, and new drugs to market

Support PBM contract strategy and client issue resolution, including:

  • Clearly defining ambiguous contract terms to help achieve more competitive market terms and rates
  • Negotiating favorable and transparent contract terms with PBMs
  • Reviewing contract terms for compliance with plan requirements and client expectations
  • Communicating complex pharmacy benefit issues clearly and resolving client questions in collaboration with the Health & Welfare consulting team
  • Building productive relationships with PBMs, vendors, clients, and internal colleagues

Professional and firm development, including:

  • Providing guidance and mentorship to colleagues
  • Participating in training and professional development to further pharmacy benefit and PBM expertise
  • Contributing to Health & Welfare Practice and firm initiatives as needed
  • Supporting special projects or assignments related to pharmacy benefits and PBM consulting

Necessary Skills and Attributes:

  • Strong PBM industry knowledge, including pharmacy benefit oversight, plan design, PBM procurement, claim auditing, pricing audits, rebate auditing, and contractual review
  • Ability to advise clients on pharmacy matters, including formulary structure and new drugs to market
  • Entrepreneurial team player who can multitask and work independently
  • Engaged, flexible, collaborative, and proactive, with the ability to positively impact strategic and tactical initiatives
  • Excellent communication, judgment, creative problem-solving, negotiation, and conflict resolution skills
  • Ability to operate as an effective tactical and strategic thinker
  • Ability to work in a fast-paced environment, manage multiple priorities, and maintain a high level of accuracy and productivity
  • Strong written, verbal, interpersonal, and presentation skills
  • Computer / software skills: Strong proficiency with general Office software such as Word, Excel, PowerPoint, Outlook, SharePoint, Teams
Preferred Education and Experience:
  • Work Experience: Minimum of 5 years of experience in Pharmacy Benefit Management as an Account Executive, Account Manager, or Clinical support, including auditing PBM contracts and pharmacy benefits
  • Education: Business, Science, Communication, or Math degree
Location and Travel:
  • This Pharmacy Benefit Consultant position may be based in Seattle, Washington or Southern California, with flexibility to work remotely much of the time. Some travel is required, up to approximately 30%, including overnight travel to client meetings within the Western U.S.
Company Culture:

We are a friendly, professional team and are open to flexible work arrangements (including working from home and some schedule flexibility), as long as business needs are covered.

At Rael & Letson, we are committed to a culture of diversity and inclusiveness, as demonstrated through our recruitment, retention, and employee development programs. We maintain an environment that respects and builds on the assets and talents of each person, valuing their unique backgrounds including - but not limited to - gender and gender identity, race, ethnicity, sexual orientation, disability status, veteran status, age, and religion. Fostering a diverse and inclusive environment is critical to our success, allows us to attract and retain the best talent and enables us to support one another’s professional success.

Total Comp and Benefits:

In addition to competitive base pay, this position is eligible for our annual bonus program.

We are proud to offer excellent benefits including a 401k with a 5% company contribution, available medical, dental, vision, life and disability coverage, ESOP, generous time off, and more.