Pharmacy Analyst Jobs

About The Position

Requirements

• 4–6 years of experience in healthcare analytics, pharmacy analytics, PBM operations, claims auditing, or a related field.
• Advanced SQL skills and the ability to analyze large, complex datasets.
• Experience performing pharmacy reimbursement, network pricing, financial reconciliation, contract compliance, or payment-integrity analysis.
• Ability to interpret complex contractual pricing terms and convert them into documented calculations, validation rules, and analytical test cases.
• Experience investigating discrepancies across claims, pricing reference data, contract terms, adjudication logic, and financial outputs.
• Ability to quantify financial exposure and communicate material findings, assumptions, and limitations to Finance, Legal, Network, Product, and executive stakeholders.

Nice To Haves

• PBM industry experience.
• Experience with pharmacy network contracting, reimbursement analysis, effective-rate reconciliation, or contract compliance.
• Experience using drug reference and pharmacy reference data.
• Familiarity with financial controls, audit support, accrual processes, recoveries, or materiality assessment.
• Experience creating automated exception monitoring and reconciliation frameworks.

Responsibilities

• Use SQL and other analytical tools to review pharmacy claims data and validate adjudication outcomes.
• Investigate claim pricing, benefit application, reimbursement calculations, accumulators, and other claim-processing logic to identify discrepancies or errors.
• Perform root cause analyses on adjudication issues and partner with stakeholders to develop corrective actions.
• Develop repeatable monitoring and surveillance processes to identify anomalies, trends, and potential financial or operational risks.
• Collaborate with Finance, Legal, Product, Operations, Network, and Compliance teams to interpret requirements and assess claim-processing outcomes.
• Support audits, regulatory reviews, contractual validations, and financial reconciliations through detailed claims analysis.
• Translate technical findings into clear, actionable recommendations for business stakeholders.
• Participate in cross-functional discussions to evaluate system changes, benefit implementations, and operational processes.
• Develop and maintain SQL queries, reports, dashboards, and analytical tools that support claims oversight and operational decision-making.
• Ensure analyses are accurate, well-documented, reproducible, and supported by appropriate quality controls.
• Identify opportunities for automation and process improvement to increase efficiency and reduce risk.
• Help identify and quantify financial, operational, and compliance risks associated with claims processing.
• Validate that claims adjudicate in accordance with benefit designs, contractual requirements, and company policies.
• Maintain documentation of methodologies, business rules, findings, and remediation activities.
• Adhere to the Judi Health Code of Conduct, including reporting non-compliance.

Benefits

• Equal employment opportunity and nondiscrimination protections.