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Pharmacy Claims Analyst Jobs (NOW HIRING)

Systemart LLC

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Revenue Cycle Claims Analyst - Pharmacy

Boston, MA · Remote

$35 - $40/hr

Job Title - Revenue Cycle Claims Analyst - Pharmacy Unit - Pharmacy Revenue Cycle Duration of Assignment - 13 Weeks Location - Remote Shift - Monday-Friday, Day Shift Guarantee Hours - 40 Hours per ...

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Ryan Specialty

Pharmacy Risk Analyst

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Analyze pharmacy claims, utilization, and financial data to identify trends, risks, and savings opportunities. * Monitor specialty drug spend, gene therapies, GLP-1 utilization, and high-cost ...

Onco360

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The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ... analytical skills, Intermediate typing/keyboarding skills * Desired: Knowledge of Foundation ...

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The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ... analytical skills, Intermediate typing/keyboarding skills * Desired: Knowledge of Foundation ...

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How much do pharmacy claims analyst jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for pharmacy 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 pharmacy claims analyst?

Pharmacy Claims Analysts are professionals who review, process, and analyze pharmacy insurance claims to ensure accuracy and compliance with policies and regulations. They work for insurance companies, pharmacy benefit managers, or healthcare providers, helping to prevent fraud, resolve billing discrepancies, and verify that claims are processed in accordance with coverage guidelines. Their work is essential to making sure patients, pharmacies, and insurers are billed correctly and efficiently.

What are the key skills and qualifications needed to thrive as a pharmacy claims analyst?

To thrive as a Pharmacy Claims Analyst, you need a strong understanding of pharmacy benefit management, medical terminology, and claims processing, often supported by experience in healthcare or pharmacy settings. Familiarity with claims processing software, pharmacy benefit management (PBM) systems, and relevant certifications like Certified Pharmacy Technician (CPhT) are commonly required. Exceptional attention to detail, analytical thinking, and effective communication are vital soft skills in this role. These abilities ensure accurate claims adjudication, reduce errors, and support compliance within a complex and regulated healthcare environment.

How does a pharmacy claims analyst typically collaborate with pharmacists and insurance providers to resolve claim discrepancies?

Pharmacy Claims Analysts frequently interact with both pharmacists and insurance providers to investigate and resolve discrepancies in claims. This involves reviewing claim details, clarifying drug coverage policies, and facilitating communication between pharmacies and payers to ensure accurate adjudication. Effective analysts must balance attention to detail with strong interpersonal skills to resolve issues efficiently, often working as part of a larger team that includes billing specialists and customer service representatives. These collaborations are essential for maintaining compliance, minimizing errors, and supporting timely reimbursement.

What is the difference between Pharmacy Claims Analyst vs Pharmacy Technician?

AspectPharmacy Claims AnalystPharmacy Technician
CredentialsOften requires a certification or relevant experienceHigh school diploma or equivalent; certification optional
Work EnvironmentOffice setting, analyzing claims dataPharmacy or retail setting, assisting pharmacists
Industry UsageInsurance companies, healthcare providersRetail pharmacies, hospitals
Job FocusReviewing and processing insurance claims, resolving discrepanciesPreparing medications, customer service, dispensing

The main difference between a Pharmacy Claims Analyst and a Pharmacy Technician lies in their roles and focus. The analyst primarily reviews and manages insurance claims data, often requiring specialized certifications, while the technician assists pharmacists with dispensing medications and customer service. Both roles are essential in the pharmacy and healthcare industry but serve distinct functions.

More about Pharmacy Claims Analyst jobs
What cities are hiring for Pharmacy Claims Analyst jobs? Cities with the most Pharmacy Claims Analyst job openings:
What states have the most Pharmacy Claims Analyst jobs? States with the most job openings for Pharmacy Claims Analyst jobs include:
What job categories do people searching Pharmacy Claims Analyst jobs look for? The top searched job categories for Pharmacy Claims Analyst jobs are:
Pharmacy Claims Analyst jobs near you
Infographic showing various Pharmacy Claims Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 69% Full Time, 27% Part Time, and 3% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Revenue Cycle Claims Analyst - Pharmacy

Systemart LLC

Boston, MA • Remote

$35 - $40/hr

Full-time

Posted 2 days ago

New

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Job description

Job Title – Revenue Cycle Claims Analyst – Pharmacy

Unit – Pharmacy Revenue Cycle

Duration of Assignment – 13 Weeks

Location – Remote

Shift – Monday–Friday, Day Shift

Guarantee Hours – 40 Hours per Week

Salary Range – Competitive

Job Duties:

  • Research, resolve, and process pharmacy claims, denials, and payer rejections.
  • Analyze reimbursement, contracts, billing accuracy, and payment variances.
  • Review Medicare, Medicaid, and commercial payer billing requirements.
  • Monitor claims work queues, referrals, authorizations, and billing edits.
  • Ensure accurate coding, charge capture, and timely claim submission in EPIC.
  • Collaborate with revenue cycle, pharmacy, and clinical teams to improve reimbursement and reduce denials.
  • Investigate outstanding accounts and ensure compliance with federal, state, and payer regulations.
  • Prepare reports, identify workflow improvements, and serve as a subject matter expert for complex pharmacy claims.

Requirements:

  • Bachelor's degree in Business, Healthcare, or a related field (or equivalent experience).
  • 1–3 years of experience in healthcare revenue cycle, medical billing, coding, patient accounting, or pharmacy reimbursement.
  • Experience with EPIC, CMS-1500 claims, Medicare, Medicaid, and commercial insurance billing preferred.
  • Knowledge of CPT, HCPCS, ICD-10, NCCI edits, MUE edits, NDC numbers, and pharmacy billing workflows.
  • Strong analytical, problem-solving, communication, and organizational skills.
  • Certified Pharmacy Technician (CPhT) and/or CPC/RHIT certification preferred.

Company Description

Systemart is in business for 25 years and recently awarded as Best Staffing Firm to work for in 2025.