Pharmacy Benefits Claims Analyst
$71.7k - $131.91kMilliman, Inc
We are looking for a Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. What You Will Do In this role, you will: Design and conduct data-driven analyses using pharmacy claims data and complex modeling. Participate actively as a member of a multi-disciplinary analytics team, fostering the sharing of relevant information to help identify creative solutions to complex problems. Explain results of analyses to internal teams and provide valuable insights, both orally and in clear, concise client reports. Stay current on industry trends, regulations, and best practices in pharmacy benefit management. Contribute to the development of innovative methodologies and tools for pharmacy claims analytics. What We Are Looking For Professional Qualifications Minimum of 4 years of PBM or healthcare analytics experience including at least 2 years of experience specific to PBM analytics. Working knowledge of Microsoft Office suite, including proficiency in Excel and SQL Server. Proficiency working with and explaining movements in key PBM performance indicators and pharmacy claims statistics. Knowledge of formularies, pharmacy claims data and their nomenclatures, including NDC, AWP, PBM, WAC, etc. Knowledge of claims data and how these manifest in claim adjudication and downstream analyses. Personal Qualifications Strong time management and people management skills. Experience working in a dynamic environment, demonstrating adaptability and integrity. Strong technical communication skills, written and oral. Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in the future. The Team The San Diego Health practice includes employees with diverse areas of experience and expertise in the pharmacy space. Current employees include those that have worked as actuaries, PBM analysts/consultants, pharmacists, and pharmacy technicians. Location This role is based out of the Milliman office in San Diego, California, but candidates hired into this role may work remotely anywhere in the US. The expected application deadline for this job is June 22, 2026. Compensation The overall range for this role is $71,700 - $131,905. For candidates residing in: Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, New York City, Pennsylvania, Virginia, Washington, or the District of Columbia the range is $82,455 - $131,905. All other locations the range is $71,700 - $114,700. Benefits We offer a comprehensive benefits package designed to support employees' health, financial security, and well-being. Benefits include: Medical, Dental and Vision - Coverage for employees, dependents, and domestic partners. Employee Assistance Program (EAP) - Confidential support for personal and work-related challenges. 401(k) Plan - Includes a company matching program and profit-sharing contributions. Discretionary Bonus Program - Recognizing employee contributions. Flexible Spending Accounts (FSA) - Pre-tax savings for dependent care, transportation, and eligible medical expenses. Paid Time Off (PTO) - Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis. Holidays - A minimum of 10 paid holidays per year. Family Building Benefits - Includes adoption and fertility assistance. Paid Parental Leave - Up to 12 weeks of paid leave for employees who meet eligibility criteria. Life Insurance & AD&D - 100% of premiums covered by Milliman. Short-Term and Long-Term Disability - Fully paid by Milliman. Equal Opportunity All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, national origin, disability, or status as a protected veteran. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Milliman, Inc
$17.98 - $32.12 per hour
...improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will... ...thoroughly review, analyze and research complex healthcare claims in order to identify discrepancies, verify pricing, confirm prior...SuggestedHourly payMinimum wageFull timeWork experience placementLive inWork at officeLocal areaRemote workMonday to FridayShift work$17.98 - $32.12 per hour
A leading healthcare organization in San Diego is seeking a Claims Processor to work in a hybrid model. In this full-time position, you... ...salary ranges from $17.98 to $32.12 per hour. Comprehensive benefits and career development opportunities are offered. #J-18808-Ljbffr...SuggestedHourly payFull time$125k - $140k
...Services is looking for a client-facing professional in San Diego to analyze and deliver financial solutions for clients with complex benefit programs. Responsibilities include developing strategic plans, providing expert underwriting insights, and leveraging analytical...Suggested$125k - $140k
...prospective clients and clients with complex benefit programs. Responsibilities Act as a... ...clients. Reporting packages may include: Claims utilization, trend, and lag analyses Rate... ...and reviewer. Mentor all level analysts via their reviewed work. Develop and maintain...SuggestedWork at office$59.1k - $120.2k
...ADP is hiring a Lead Claims Examiner. In this position you will perform the following basic functions: Supervisory responsibility... ...the form of bonus, equity or commissions. We offer the following benefits: Medical, Dental, Vision, Life Insurance, Matched Retirement...SuggestedMinimum wageTemporary workLocal areaRemote work$84.82k - $116.37k
...Senior Claims Professional BHHC has an immediate opportunity for experienced Workers Compensation Claims Professionals. This position... ...effective decision making in compensability determinations and benefit authorizations (within designated authority parameters)....Work at officeImmediate startWork from homeFlexible hours2 days per week- K2 Claims Services, LLC is seeking a General Liability Adjuster for a remote role with travel requirements. The ideal candidate has over... ...management. The position offers a competitive salary, medical benefits, and a collaborative team environment. A California adjuster's...Remote work
$45 - $50 per hour
...challenges. You will receive competitive rewards and access to benefits programs and world-class learning resources. Accenture Flex... .... Job Description: Epic Certified Professional Billing Claims Analyst will bring experience in managing applications, with a strong...Hourly payLive inWork at officeLocal areaFlexible hours$80k - $140k
...underwriting, quoting, and relationship management. Review claims activity, inspection reports, and loss control recommendations,... ...The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include...Full time$80k - $135k
...state. Preferred serves 10,000 policyholders and provides medical claims handling and claims management for policyholders as needed to... ...The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include...Full time$38.5 - $43.3 per hour
...role Minimum 2 years specific to Non-QM loan products Work Environment: This is a remote position. Compensation and Benefits: Estimated Rate of Pay: $38.50 - $43.30 This position is full-time; non-exempt. The estimated range is the budgeted amount...Full timeWork at officeLocal areaRemote work$21 - $27 per hour
...hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for the role. Teammate Benefits & Total Well-Being We go beyond standard benefits, focusing on the total well-being of our teammates, including: Health Benefits :...Hourly payFull time$80k - $130k
...discretionary annual incentive program. ?Chubb offers a comprehensive benefits package, more details on which can be found on our careers... ...financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we...Local area$40.86 - $50.48 per hour
...position is a full‑time, non‑exempt, remote underwriting role. The analyst will evaluate consumer home loan applications—including... ...Environment This is a remote position. Compensation and Benefits Estimated hourly rate: $40.86 – $50.48. Full‑time, non‑exempt...Hourly payFull timeWork at officeLocal areaRemote work$100k - $135k
...business goals Collaborative partner with the branch, home office, claims, marketing and operations Experience with Agency and Broker... ...annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found at The disclosed pay...Full timeTemporary workLocal areaHome office$99.56k - $150.46k
...experience, backed up a worldwide team of risk consultants and claims specialists. When it comes to underwriting insurance products... .... As part of our comprehensive compensation and highly rated benefits programs, employees are also eligible for annual performance-based...Contract workLocal areaRemote workWorldwideVisa sponsorshipWork visa$36.06 - $49.95 per hour
...a clear path toward senior underwriting or leadership opportunities. We Offer Comprehensive medical, vision and dental benefits that give you peace of mind. Hybrid work schedule allowing you to split your week between coming into the office and working remotely...Hourly payWork at officeRemote workWork from homeFlexible hours$125k - $175k
...Mentor and provide guidance to junior underwriters and credit analysts; may oversee a small team Participate in policy development... ...Office Suite (especially Excel and PowerPoint) Axos Employee Benefits May Include: ~ Medical, Dental, Vision, and Life Insurance...Work at officeLocal area- ...company in San Diego is seeking a General Adjuster to investigate claims involving personal, casualty, or property loss. This role... ...and customer service skills. The company offers a comprehensive benefits package including medical, dental, and life insurance. #J-18808...
$45 - $50 per hour
Job Description Epic Certified Hospital Billing Claims Analyst will bring experience in managing applications, with a strong background in... ...New Jersey: $45.00 to $50.00 Washington: $45.00 to $50.00 Benefits Accenture Flex offers a market competitive suite of benefits...Live inWork at officeLocal areaFlexible hours$62.7k - $81.3k
...Workers' Compensation Claims Representative Are you ready to make a meaningful impact in the world of workers' compensation? Join... ...discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers...- ...Are you an experienced Claims Analyst with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced Claims Analyst to work at their company in San Diego, CA. Primary Responsibilities/Accountabilities:...
- ...A leading insurance provider is seeking a Claims Adjuster to manage insurance claims efficiently while participating in a comprehensive... ...a preference for experience in customer service. Comprehensive benefits and support for work-life balance are offered, alongside...Remote work
$78.1k - $109.4k
...Esis Senior California Claim Representative Are you ready to make a meaningful impact in the world of workers' compensation? Join... ...discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers...Full timeTemporary workWork at officeLocal area$61.05k - $98.33k
...The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability... ...: $61,053 - $98,334 A list of our benefit offerings can be found on our CorVel website... ...employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health...Minimum wageFull timeWork at officeLocal areaRemote workFlexible hours- ...Workers' Compensation Claims Adjuster Are you searching for a unique opportunity that offers exceptional training and career growth... ...building Generous Paid Time Off and Holidays Excellent Benefits (Medical, Dental, Vision, 401k, etc) Health and Wellness Reimbursement...Hourly payTraineeshipWork from home
$90k - $110k
...Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture. Deliver innovative... ..., and your career path. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional...Local areaFlexible hours$27.69 per hour
...Work® Fortune Best Workplaces in Financial Services & Insurance Claims Representative (IAP) - Workers Compensation Training Program... ...through increasing responsibilities. A diverse and comprehensive benefits package to take care of your mental, physical, financial and professional...TraineeshipWork at officeFlexible hours$78.68k - $132.69k
...better everyday! Learn more about why you want to be here! The Claims Specialist position is responsible for handling complex claims... ...$78,678.61 - $132,686.15 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary...Full timeWork at officeLocal area$120k - $145k
...Job Description Senior Casualty Claims Examiner - Construction Defect Job Summary Seeking an experienced and dedicated... ...Salary Range : $120,000 - $145,000+ (depending on experience) Benefits : Competitive benefits package, 401(k), paid time off,...Remote work
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