Pharmacy Benefits Claims Analyst

Milliman

Pharmacy Benefits Claims Analyst in a remote role analyzing pharmacy claims data and modeling. Joining a multidisciplinary team to foster innovative solutions in pharmacy benefit management.

Posted 5/6/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $71,700 - $131,905 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.
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.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysispharmacy claims analyticsmodelingSQLExcelperformance indicatorsclaims adjudicationmethodologiespharmacy claims statisticsformulary knowledge

Soft Skills

time managementpeople managementadaptabilityintegritytechnical communicationoral communicationwritten communicationteam collaborationproblem-solvingcreativity