Pharma Claims Analytics Specialist

Forhyre; Kentucky; On-site; USD 70,000 - 110,000; Full time

Job summary

Forhyre is seeking a Claims Business Analyst to bridge IT capabilities and business objectives, supporting analysis, building, testing, and deployment of our software features for claims processing. You will collaborate with the Director of Claims to ensure timely payment, optimize call flows, improve quality and customer experience, and develop dashboards and reports.

The role requires strong Excel, data analysis and industry knowledge of pharmacy benefits, with agile project experience and

Qualifications

• Experience with technology, IS departments.
• Advanced Microsoft Excel.
• ICD-10 and CPT-4 coding knowledge.
• Windows, Word, and business analytics tools.
• Strong analytical and problem-solving skills.
• Excellent communication across levels (staff to management).
• Pharmacy claims processing background.
• Payer/PBM market experience.
• Pharmacy claim workflow understanding (Enrollment, Drug Utilization).
• Pharmacy Benefit Systems knowledge.

Responsibilities

• Develop KPIs for claim processing and call center performance.
• Automate work distribution and maintain dashboards.
• Generate weekly/monthly/quarterly departmental reports.
• Summarize and distribute operational, claim data and call metrics.
• Ensure on-time deliverables and communicate issues to leadership.
• Identify data trends and provide actionable recommendations.
• Refine tools with managers for efficiency.
• Create data definitions, validate data, and merge sources.
• Coordinate reports and discuss system changes with other departments.

Skills

Excel advanced

Data analysis

Pharmacy claims

Stakeholder comms

Business analytics tools

Tools

Windows

Word

Business analytics tools

Job description

Forhyre is seeking a Claims Business Analyst to bridge IT capabilities and business objectives, supporting analysis, building, testing, and deployment of our software features for claims processing. You will collaborate with the Director of Claims to ensure timely payment, optimize call flows, improve quality and customer experience, and develop dashboards and reports.

The role requires strong Excel, data analysis and industry knowledge of pharmacy benefits, with agile project experience and