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How much do pharmacy claims analyst jobs pay per hour?

As of Aug 21, 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.

Is claims processing a stressful job?

Pharmacy claims analysts often work in a fast-paced environment where accuracy and attention to detail are essential, which can contribute to work-related stress. The job involves managing large volumes of data, adhering to strict deadlines, and resolving complex issues, but stress levels vary depending on workload, support systems, and individual coping skills.

What does a pharmacy claims analyst do?

A pharmacy claims analyst reviews and processes insurance claims related to prescription medications, ensuring accuracy and compliance with policies. They analyze claim data, identify discrepancies, and work with healthcare providers and insurance companies to resolve issues, often using specialized software and data analysis skills.
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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, 69% Full Time, 27% 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 Adjudication Specialist

Onco360

Albuquerque, NM • Remote

$22/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy working in Mountain Time Zone. This will be a Full-Time position. This is a remote/hybrid opportunity,
Shift times start at 10am Mountain Time Zone until 8pm Mountain Time Zone.
Full-Time position may work remotely but MUST HAVE ACTIVE NEW MEXICO PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $22.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documenst and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

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