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Pbm Claims Analyst Jobs (NOW HIRING)

Johns Hopkins Health System

Vendor Auditor

Hanover, MD · On-site

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 ...

Moda Health

RX Prior Authorization Coord I

Portland, OR

$21.30 - $23.96/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Must be able and willing to learn a third-party real-time interactive PBM claims adjudication ... Sound analytical problem solving, decision making, memory retention, and organizational skills.

Rael & Letson

Associate Pharmacy Benefit Consultant

Seattle, WA · Remote

$120K - $155K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

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 ...

Elevance Health

Sr Test Analyst PBM (Business Analyst III)

Mason, OH · Hybrid

$87K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Sr Test Analyst PBM (Business Analyst III) Hybrid: This role requires associates to be in-office 1 ... 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

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

Johns Hopkins Healthcare

Vendor Auditor

Hanover, MD · On-site

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 ...

State of Vermont

Market Conduct PBM Examiner

Montpelier, VT · On-site

  • Medical

  • Dental

  • Life

  • Retirement

The work involves reviewing PBM contracts with health plans and pharmacies, analyzing pharmacy claims data, writing comprehensive reports on findings, and working with entities on compliance plans.

Webilent Technology, Inc.

Business Analyst

Coppell, TX · On-site

Required Skills: 5+ years of Business Analyst experience in healthcare technology, health plan, PBM, TPA, or payer environments. Hands-on experience with healthcare claims, adjudication logic, COB ...

New

Forhyre

Claims Business Analyst

Charlotte, NC

We are looking for a Claims Business Analyst who will be the vital link between our information ... Experience working within the Payer / PBM market (in particular Medicare and Medicaid, Part D and ...

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All JobsPbm Claims Analyst Jobs

Pbm Claims Analyst information

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$27

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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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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.

Pharmacy Technician - PBM Services & Analytics

CommUnityCare Health Centers

Austin, TX • Remote

$17 - $20.75/hr

Full-time

Re-posted 2 days ago

Job description

The Pharmacy Technician - PBM Services & Analytics supports the Pharmacy Benefits Program Manager by providing data-driven insights, financial analysis, and subject matter expertise on pharmacy benefit management operations. This role is critical in ensuring strategic alignment, operational efficiency, and informed decision-making across PBM-related initiatives. The ideal candidate will have a pharmacy technician background combined with strong analytical skills and experience in healthcare data analysis.

**For this position, 0.2 FTE will be dedicated to performing Pharmacy Technician - PBM Services responsibilities and 0.8 FTE will be allocated to analytic operations.**

**Remote = Individuals in this position may work at an approved off-site location. They may be required to occasionally visit an on-site location in Austin, Texas, so to be considered, candidates must live in the greater Austin area.**

** The ideal candidate will have financial analytic skills, and experience using Excel and spreadsheets **


Job Functions

Essential Functions:

  • Develop and maintain regular and ad hoc reports on PBM performance, utilization, cost trends, and rebate activity.
  • Conduct financial and data analyses to support formulary decisions, contract evaluations, and cost containment strategies.
  • Monitor and interpret PBM policies, regulatory changes, and payer requirements to inform internal stakeholders
  • Prepare briefing materials and data summaries for PBM-related meetings, including payer negotiations and internal strategy sessions.
  • Collaborate with finance, clinical pharmacy, and IT teams to ensure data accuracy and integration across systems.
  • Support the PBM in strategic planning, vendor management, and performance improvement initiatives
  • Serve as a liaison between PBM operations and other departments, translating technical data into actionable business insights.
  • Serve as liaison between Patient Assistance Programs, patients, clinic staff, eligibility staff and outsourced pharmacies.
  • Support the PBM technicians and call center as needed.
  • Perform other duties as assigned to support broader medication access initiatives.
  •  

Knowledge, Skills and Abilities:

  • Knowledge or experiency with 340B program, 340B data and reporting.
  • Knowledge of retail pharmacy, pharmacy claims, pharmacy benefits design and pharmcy reimbursement models.
  • Demonstrate extensive knowledge of medical/pharmaceutical terms and nomenclature.
  • Excellent organizational, communication and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Work with multi-functional teams to complete projects.
  • Develop and maintain favorable internal relationships, partnerships with co-workers.
  • Demonstrated familiarity with tools, technology, and systems typically found within most health care environments (i.e. personal computer skills, word processing, patient records systems, EMR systems, etc.)
  • Be proficient in data analysis tools such such as Excel, SQL, Power BI/Tableau.
  • Complete all mandatory training and maintain appropriate credentials/licensure.
  • Knowledge of Medicaid/Medicare pharmacy benefits.
  • Ability to work independently and manage multiple priorties.
  • Support executive-level meetings and decision-making.

QUALIFICATIONS

Education:

High school diploma or equivalent or equivalent -Required

Associates Degree (higher degree accepted) in healthcare, pharmacy, business, or related field -Required

Work Experience:

Three (3) years pharmacy operations, managed care, PBM or healthcare analytics -Required

Bilingual in Spanish -Preferred

Licenses and Certifications:

Current Pharmacy Technician Registration with the Texas State Board of Pharmacy Upon Hire -Required

340B University Within 6 Months -Required

National Certification with the Pharmacy Technician Certification Board (CPhT) -Preferred

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