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Pbm Claims Analyst Jobs (NOW HIRING)

ProCare Rx

PBM Rebate Data Associate

Gainesville, GA · On-site

$14.75 - $19.25/hr

Provide Rebate Manager support in day to day functions, including the submission of claims files to ... Identify, analyze, prioritize and resolve rebate & RFP data/reporting issues. * Perform ad-hoc data ...

MedWiz Pharmacy

PBM Audit Manager

Cherry Hill, NJ · On-site

$102K - $134K/yr

Pharmacy Audit Manager?- Billing & Insurance Claims FLSA Status:? Non-Exempt? Reports to:? Director ... Review and analyze audit requests, documentation, and findings to ensure accuracy and compliance ...

Msmc

Office Coordinator Medicare Part D

Hialeah, FL

$16.25 - $21.75/hr

Assists with all Part D activities including: annual bid, Fraud Waste and Abuse Plan, PBM claims ... collecting, analyzing and reporting identifying measures. Schedules, attends and presents ...

Forhyre

Claims Business Analyst

Charlotte, NC · On-site

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 ...

Forhyre

Claims Business Analyst

Charleston, WV · On-site

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 ...

ProCare Rx

PBM Rebate Data Associate

Gainesville, GA · On-site

$14.75 - $19.25/hr

Provide Rebate Manager support in day to day functions, including the submission of claims files to ... Identify, analyze, prioritize and resolve rebate & RFP data/reporting issues. * Perform ad-hoc data ...

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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 Jun 16, 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 jobs pay 2000 a day?

Jobs that can pay around $2,000 a day typically include specialized roles such as senior healthcare professionals, high-level consultants, certain executive positions, and skilled trades like commercial pilots or project managers in large projects. These roles often require advanced skills, certifications, extensive experience, or working in high-demand industries with high hourly or project-based rates.

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 jobs pay 500,000 a year in the US?

Jobs such as senior executives, specialized surgeons, and successful entrepreneurs can earn $500,000 or more annually. Certain high-level roles in finance, technology, and healthcare, especially with bonuses, stock options, or private practice, also have the potential to reach this income level. Achieving this often requires advanced skills, extensive experience, and sometimes ownership or leadership positions.

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 job makes $10,000 a month without a degree?

A Pbm Claims Analyst typically earns less than $10,000 per month, but some high-level or specialized roles in insurance claims analysis or related fields can reach that income level through experience, certifications, and overtime. Generally, jobs that pay $10,000 a month without a degree are rare and often involve sales, entrepreneurship, or skilled trades with significant experience or commission-based earnings.

How to become a PBM analyst?

To become a PBM claims analyst, candidates typically need a bachelor's degree in healthcare administration, pharmacy, or a related field. Relevant skills include knowledge of pharmacy benefit management, claims processing, and data analysis, often supported by certifications like the Certified Pharmacy Technician (CPhT) or similar credentials. Experience with claims processing systems and strong analytical skills are also important for this role.
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Pbm Claims Analyst jobs near you
Infographic showing various Pbm Claims Analyst job openings in the United States as of June 2026, with employment types broken down into 17% Full Time, 50% Part Time, and 33% Contract. Highlights an 47% Physical, 7% Hybrid, and 46% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Pharmacy Consulting Analyst - Remote

Unison Risk Advisors

Cleveland, OH • Remote

Full-time

Medical

Posted 3 days ago

Job description

Job Summary:

We are seeking a highly analytical and client-focused Pharmacy Consulting Analyst to join our pharmacy consulting team. This role combines strategic analytics, PBM procurement, and operational support to help employer clients optimize their pharmacy benefit programs.

The Pharmacy Consulting Analyst will support pharmacy benefit manager (PBM) RFP processes, including preparation, evaluation, and vendor negotiations, while leveraging pharmacy claims data to identify cost drivers and savings opportunities. This role is responsible for developing financial models, analyzing plan design strategies, and delivering clear, data-driven insights to support client decision-making.

In addition to strategic responsibilities, the role supports operational execution by coordinating documentation, facilitating data exchanges between PBMs and Unison Risk Advisors, ensuring compliance, and assisting with reporting and project management. The ideal candidate is detail-oriented, analytically strong, and comfortable working in a fast-paced consulting environment.

Key Responsibilities:

· Prepare, distribute, and evaluate PBM RFPs, ensuring alignment with client goals and financial competitiveness

· Assist in negotiating pricing terms, rebates, and contract provisions with PBM vendors

· Analyze pharmacy claims data to identify utilization trends, cost drivers, and savings opportunities

· Assist with modeling financial impact of plan design changes, formulary strategies, and procurement approaches

· Develop clear, data-driven client deliverables, including executive summaries and presentations

· Monitor PBM market trends, specialty drug management strategies, and regulatory developments to inform client recommendations

· Conduct benchmarking analyses comparing pharmacy pricing, programs, and performance across the market

· Support consulting teams by preparing materials for client meetings, RFP processes, and strategy reviews

· Compile reporting on claims experience, high-cost medications, and year-over-year spend trends

· Facilitate data requests and reconciliations between PBMs, clients, and internal analytics teams

· Monitor PBM service-level performance and escalate issues impacting client outcomes

· Ensure compliance with HIPAA and regulatory requirements when handling sensitive data

· Provide project coordination support, including scheduling, tracking timelines, and managing deliverables

· Maintaining paperwork, audit documentation, processing billing and invoicing information, and supporting pharmacy leadership with reporting and administrative projects

· Perform ad hoc analyses in response to client or broker requests

Qualifications:

Education & Credentials:

Bachelor of Science in Business, Healthcare Administration, or Economics Relevant Coursework: Healthcare Finance, Data Analytics, Health Policy, Pharmacy Benefit Management

Experience:

· 3+ years of experience in pharmacy benefits, PBM contracting, pharmacy analytics, or pharmacy consulting

· Strong understanding of PBM pricing models, rebate structures, formulary management, and specialty drug strategies

· Experience managing RFP processes and vendor negotiations

· Experience working with or for a PBM, health plan, or benefits consulting firm is highly desirable.

· Experience working with large data sets

Skills:

· Strong analytical and financial acumen.

· Proficiency in Excel (pivot tables, formulas, charts) and data visualization tools (e.g., Tableau, Power BI).

· Excellent written and verbal communication skills.

· Ability to manage multiple projects and deadlines in a fast-paced environment

Who You Are:

· Exceptionally organized, with the agility to move between projects quickly.

· A logical problem-solver who works independently and takes initiative.

· Consistently positive and professional, leading by example even under pressure.

· A strong communicator, both verbally and in writing, with a client-first mindset.

Employment Type: FULL_TIME

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