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Pharmacy Claims Analyst Jobs (NOW HIRING)

Onco360

$21/hr

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

Onco360

$21/hr

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

Onco360

$23/hr

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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$51

How much do pharmacy claims analyst jobs pay per hour?

As of Aug 13, 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% Internship, 1% As Needed, 74% Full Time, 22% Part Time, and 2% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Pharmacy Claims Review Manager

Consonus Pharmacy

Portland, OR • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 28 days ago

Job description

Overview
Pharmacy Claims Manager
What's your wish list for the perfect job? Maybe it's to make a positive impact in the world, or to grow your career in healthcare. Maybe working with a supportive team is top priority, or to feel respected and valued.
If your answer is "all of the above," consider joining our team at Consonus Pharmacy. It's a perfect opportunity for compassionate people dedicated to people's health and well-being.
Consonus Pharmacy is a closed-door long-term care pharmacy specializing in the needs of nursing facilities, assisted living residents, and their caregivers. We are currently hiring a Pharmacy Claims Manager to join our team!
As the Pharmacy Claims Manager your responsibilities will include (but are not limited to):
The Pharmacy Claims Manager is responsible for overseeing all pharmacy claims processing operations, including prescription adjudication, third-party billing, claim rejection management, and reimbursement optimization. This position leads a team responsible for ensuring accurate and timely claim submission, resolution of claim exceptions, compliance with PBM, Medicare Part D, Medicaid, and commercial payer requirements, and adherence to NCPDP standards.
The Pharmacy Claims Manager partners closely with Billing, Customer Accounts, and Pharmacy Operations to ensure accurate reimbursement and compliance, minimize claim write-offs, and ensure exceptional service to residents, facilities, and payers. In our Long-Term Care environment, there is focus on coordination with the Credentialing & Contracting team on payer enrollment issues, and management of LTC-specific reject queues related to transition fills, hospice billing, and facility census changes.
Some benefits may include:
  • Paid training & career advancement opportunities
  • $25,000 toward ongoing education benefit
  • Generous Paid Time Off that pools vacation, sick & holiday pay in a single bucket for flexible use
  • Medical/Dental/Vision insurance
  • Free access to MDLIVE - allowing access to your health benefits from anywhere
  • 401K With Employer Match
  • Employee Assistance Program: with free access to counseling & support services

Qualifications
  • Bachelor's degree in Healthcare Administration, Business, Finance, or related field; equivalent experience considered.
  • Minimum 5 years of pharmacy claims, third-party billing, pharmacy revenue cycle, or PBM operations experience. Long - Term Care experience preferred.
  • Minimum 2 years of supervisory or management experience.
  • Strong understanding of: NCPDP claim standards, Medicare Part D, Medicaid pharmacy billing, Managed Care reimbursement, PBM claim adjudication processes, Pharmacy revenue cycle operations.
  • Experience working with PBMs such as Express Scripts, CVS Caremark, OptumRx, Humana, Prime Therapeutics, MedImpact, and Navitus.
  • Experience managing Medicare Part D, Medicaid, and dual-eligible populations
  • Advanced analytical and problem-solving skills.
  • Proficiency with pharmacy management systems and reporting tools
  • Ability to work under pressure in fast-paced environment ensuring timely and accurate billing
  • Ability to travel to other pharmacy locations as required
  • Certified Pharmacy Technician (CPhT) preferred (can obtain after hire)

EEO Statement
"Be here. Be you."
For more than 30 years, Marquis Companies and Consonus Healthcare have been serving seniors and welcoming staff of all backgrounds, skills, and perspectives. The Marquis family of companies offer a rich heritage of embracing differences and honoring individuality. We've continued to grow in our appreciation of diversity in the workplace. We know it builds strength, drives innovation, and brings valuable new perspectives and energy.
We're committed to making our workforce an even greater reflection of the people and communities we serve, and we are honored our employees have chosen to work at Marquis and Consonus. Everything we do as a company is driven by our mission to help those we serve, and each other, live the best rest of our lives.
That means you being you - without apology or compromise. We value your every uniqueness and continue to curate, nurture, and sustain an inclusive culture. It's the foundation of who we are and the evolution of our collective future.

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