PBM Analyst

Job Overview

JOB DETAILS

REQUIREMENTS

Bachelor’s degree in Business, Finance, Mathematics, Accounting, or related field
1-2 years of relevant experience in billing, finance underwriting, or data analysis
Strong proficiency in Microsoft Excel, including formulas, pivot tables, and data manipulation
SQL or Python programming knowledge and experience
Excellent attention to detail and accuracy in data entry and analysis
Strong written and verbal communication skills
Ability to read and interpret contracts and legal documents
Experience with database management systems preferred

RESPONSIBILITIES

Execute financial and pricing models for client bids and renewals, interpreting results to identify key cost and performance drivers.
Present underwriting analyses to internal stakeholders and refine offers to achieve optimal competitiveness.
Perform detailed pharmacy claims analysis to identify and remedy variances in financial performance by recommending adjustments to pricing schedules.
Conduct studies on novel pricing phenomena and industry trends to support market-leading innovative pricing strategies.
Prepare and process client invoices, remittances, and billing files with accuracy and timeliness.
Analyze pharmacy claims and administrative fee data to identify trends and ensure compliance with contractual terms.
Interpret client contracts to extract billing requirements and flag variances impacting operational accuracy.
Collaborate with Finance, Legal, and Operations teams to streamline billing processes and resolve discrepancies.
Analyze pharmacy claims and rebate data to identify cost drivers, trends, and performance variances.
Evaluate client-level rebate guarantees and forecasting models to support underwriting and renewals.
Partner with Clinical and Formulary teams to assess the financial impact of formulary decisions and new drug launches.
Support audit and internal control documentation, ensuring rebate data accuracy and transparency.
Build and deliver PBM pricing analytics, such as copay modeling, formulary impact reports, and executive dashboards.
Conduct studies on industry trends and regulatory changes to inform innovative pricing and market strategies.
Maintain and validate critical datasets including drug lists, network data, and rebate or pricing structures.
Participate in process improvement initiatives to enhance scalability, efficiency, and data integrity.

Are you interested in this position?

Apply by clicking on the “Apply Now” button below!

#CrossChannelJobs#JobSearch
#CareerOpportunities#HiringNow
#Employment#JobOpenings
#JobSeekers
FacebookLinkedIn