Pharmacy Benefit Analyst

Job Description

Location: Remote (US-based)

We are seeking a Pharmacy Benefit Analyst to turn pharmacy claims data into formulary strategy, specialty drug decisions, and measurable plan savings. This position is a full-time, direct hire opportunity available fully remote within the United States.

This role is best aligned for a pharmacy benefit or managed care analytics professional who wants to move past reporting and into decisions that shape formulary design and benefit performance. You will build the financial models behind tier placements and PA criteria, quantify biosimilar and generic opportunities, and bring the analysis that formulary committees actually act on. The ideal candidate works fluently in claims data, understands how rebates and drug pricing benchmarks interact, and can explain a complex analysis to a plan sponsor as easily as to an actuary.

Responsibilities:

• Extract and analyze pharmacy claims data to identify high-cost utilization patterns and savings opportunities
• Prepare drug review packages, therapeutic class analyses, and financial models for formulary committee review
• Model the financial impact of formulary changes, tier placements, and prior authorization criteria using claims and pricing data
• Evaluate generic substitution and biosimilar opportunities, quantifying savings and building adoption business cases
• Produce recurring pharmacy benefit performance reporting covering spend trends, utilization rates, and compliance metrics
• Respond to analytical requests from account, clinical, and executive teams with documented, reproducible deliverables
• Monitor CMS Part D, Medicaid PDL, and USPSTF updates and assess formulary compliance implications
• Analyze specialty drug utilization trends and Limited Distribution Drug channel performance to identify optimization opportunities
• Support rebate reconciliation by mapping formulary positions to contracted lists and validating eligibility

Qualifications:

• Bachelor’s degree in Pharmacy, Health Informatics, Finance, Statistics, Business, or a related field required
• Minimum of 3 years of experience in pharmacy benefit management, healthcare analytics, or health plan operations required
• Advanced Excel skills including pivot tables, lookups, and financial modeling required
• Proficiency in SQL required; SAS, Tableau, or Power BI experience preferred
• Working knowledge of formulary management including therapeutic reviews, utilization management programs, and tier architecture
• Understanding of drug pricing benchmarks such as AWP, WAC, and NADAC, along with rebate mechanics and PBM, plan, and manufacturer contractual relationships
• Knowledge of Medicare Part D, Medicaid PDL, or commercial pharmacy benefit design required; multi-line exposure preferred
• Strong communication skills with the ability to present analytical findings to both technical and non-technical audiences

Schedule:

• Full-time position, Monday through Friday
• Fully remote within the United States
• Standard business hours with schedule flexibility

Salary Range:

The salary range for this position is approximately $75,000 – $92,000 annually ($36.06 – $44.23 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.