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Pbm Claims Analyst Jobs (NOW HIRING)

Elevance Health

Sr Test Analyst PBM (Business Analyst III)

Mason, OH · Hybrid

$87K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Sr Test Analyst PBM (Business Analyst III) is responsible for serving as the liaison between ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM (Business Analyst III)

Durham, NC · Hybrid

$89K - $115K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Sr Test Analyst PBM (Business Analyst III) is responsible for serving as the liaison between ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

CVS Health

PBM Underwriting - Senior Analyst

Scottsdale, AZ · On-site

$46K - $102K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... pharmacy claims data and build forward looking financial forecasts and profit and loss (P&L ... data analysis PREFERRED QUALIFICATIONS: - Basic knowledge of PBM finance - Experience managing ...

Elevance Health

Sr Test Analyst PBM

Independence, OH · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Grand Prairie, TX · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Tampa, FL · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Indianapolis, IN · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Winston Salem, NC · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Mason, OH · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Miami, FL · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Durham, NC · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

Elevance Health

Sr Test Analyst PBM

Atlanta, GA · Hybrid

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM Hybrid: This role requires associates to be in-office 1-2 days per week ... Validation of Formulary, Utilization Management & Drug List setup using Claims/Query testing.

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Showing results 21-40

All JobsPbm Claims Analyst Jobs

Pbm Claims Analyst information

See salary details

$14

$27

$51

How much do pbm claims analyst jobs pay per hour?

As of Aug 15, 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 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?

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 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.
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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:

What job categories do people searching Pbm Claims Analyst jobs look for?

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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 85% Full Time, 7% Part Time, 1% Temporary, and 7% Contract. Highlights an 80% Physical, 8% Hybrid, and 12% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Manager, Pharmacy Operations/Pharmacy Benefit Management (Remote)

Molina Healthcare

Remote

$59K - $129K/yr

Other

Posted 9 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

164th of 308 rated insurance

Job description

JOB DESCRIPTION Job Summary

Leads and manages team of pharmacy operations staff and Pharmacy Benefit Manager(PBM) activities. Responsible for oversight of delegated services, implementation of new products and services, and maintenance of business. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.

Essential Job Duties

  • Hires, trains, develops and manages team responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, and delivering products through the design process to completion.

  • Supports Medicaid and Marketplace lines of business.

  • Provides surveillance and oversight of delegated functions.

  • Analyzes and interprets data to identify erroneous execution of the pharmacy benefit by the Pharmacy Benefit Manager (PBM).

  • Reviews the daily inventory of "outliers" and remediates as required.

  • Reviews protocols for accuracy and compliance, including: claims, contracts, overrides, network, digital, etc.

  • Supports internal/external pharmacy audits.

  • Monitors state and federal landscape for new opportunities.

  • Collaborates with cross-functional partners to implement new products and services and supports maintenance of existing business.

  • Develops and maintains requirements, user stories, test scenarios and test cases.

  • Supports testing execution and defect management.

  • Reviews and interprets member eligibility, claim history, and pharmacy benefit information using the PBM claims software to provide information to both internal and external clients.

  • Serves as PBM liaison for real-time support on pharmacy benefit interpretation or issues.

  • Identifies and assists to remediate gaps and/or deficiencies in current pharmacy processes, tools, reports, and dashboards.

  • Develops and maintains pharmacy job aids, policies, and process documents.

  • Develops team members acumen in pharmacy services.

Required Qualifications

  • At least 7 years of pharmacy experience, and at least 5 years of experience in Pharmacy Benefit Manager(PBM), and 4 years of experience in managed care, or equivalent combination of relevant education and experience.

  • At least 1 year of health care management/leadership experience.

  • Strong data analysis skills and attention to detail.

  • Strong organizational and problem-solving skills.

  • Knowledge of processes and systems, and ability develop and deliver necessary training to departmental staff and internal customers.

  • Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies and vendors.

  • Ability to meet established deadlines.

  • Ability to function independently and manage multiple projects.

  • Excellent verbal and written communication skills.

  • Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications

  • Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $59,810.6 - $129,589.63 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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