Remote – Pharmacy Reimbursement / Claims Analyst Full Time NEW

Job Description:

We are seeking a Pharmacy Reimbursement / Claims Analyst to support pharmacy claims review, reimbursement analysis, discrepancy identification, and recovery efforts. This is a remote, part-time position with the potential to grow into a full-time role based on performance and business needs. This role is ideal for someone with experience in pharmacy claims, pharmacy reimbursement, adjudication review, PBM-related operations, or pharmacy revenue integrity. The right candidate should be comfortable reviewing claim and payment data, identifying issues, investigating root causes, documenting findings, and helping move cases through the full recovery process from identification to resolution.

Responsibilities:

• Review pharmacy claims and reimbursement data for discrepancies, variances, and missed revenue opportunities
• Analyze payment trends, underpayments, reversals, and other reimbursement-related issues
• Investigate adjudication results and identify potential recovery opportunities
• Support the full recovery process, from identifying reimbursement issues to documenting findings, organizing evidence, tracking progress, following up, and helping move cases toward resolution
• Prepare and maintain organized case files, summaries, and supporting documentation
• Track recovery cases through each stage and help ensure items move through the process to completion
• Prepare clear findings and communicate issues in a structured, organized way
• Support reporting, internal tracking, and reimbursement analysis workflows
• Help improve internal processes related to reimbursement review and recovery case management

Preferred Background:

• Experience in pharmacy reimbursement analysis, pharmacy claims analysis, PBM operations, specialty pharmacy reimbursement, or related pharmacy financial analysis
• Strong understanding of pharmacy claims, adjudication, reimbursement logic, and payment review
• Experience reviewing claim/payment data and identifying discrepancies or recovery opportunities
• Strong analytical, investigative, and documentation skills
• Detail-oriented and able to work independently
• Comfortable working with spreadsheets, reports, and structured data

Nice to Have:

• Experience in retail pharmacy, specialty pharmacy, managed care pharmacy, or PBM environments
• Familiarity with payment variance review, reimbursement dispute research, or revenue recovery analysis
• Advanced Excel or spreadsheet skills
• Experience organizing cases, tracking follow-up items, and managing issue resolution workflows

Work Arrangement:

• Remote
• Part-time
• Potential to become full-time over time