Pharmacy Claims Analyst – Remote USA

School Result; United States; Remote; USD 47,000 - 67,200; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Educational assistance

Inclusive work culture

100% remote work environment

Job summary

A healthcare technology company is seeking a Pharmacy Post-Payment Claims Analyst to join its remote team. The role involves analyzing pharmacy claims to identify errors and improve compliance with federal regulations. Ideal candidates are certified pharmacy technicians with claims analysis experience and strong analytical skills. The position offers a competitive salary, a flexible work environment, and opportunities for professional growth.

Qualifications

• Minimum of 2 years of experience in claims analysis, processing, benefit configuration, or QA/auditing in healthcare.
• Strong understanding of pharmacy claims payment configuration processes and systems.
• Proven pharmacy claims processing knowledge.

Responsibilities

• Investigate Ohio Medicaid pharmacy claim overpayments through post-payment audits.
• Analyze pharmacy claims for completeness, accuracy, and payment determination.
• Develop and update educational documents and workflows for business units.

Skills

Claims analysis

Attention to detail

Analytical skills

Communication skills

Documentation skills

Education

Bachelor’s degree in business, audit, healthcare or related field

National certification as a Pharmacy Technician (CPhT)

Job description

Gainwell Technologies is hiring a full-time Pharmacy Post-Payment Claims Analyst to join its remote team across the United States. Offering a competitive salary range of $47,000 to $67,200 per year, this role is ideal for certified pharmacy technicians with experience in claims analysis and a strong understanding of Medicaid pharmacy payment systems.

This position plays a critical role in identifying overpayments and inaccuracies in post-payment pharmacy claims, particularly within the Ohio Medicaid program. If you’re detail-oriented, analytical, and passionate about improving healthcare operations, this opportunity offers flexibility, growth, and impact.

About Gainwell Technologies

Gainwell Technologies is a leading provider of technology solutions for healthcare programs, with a focus on Medicaid and public health services. With over 50 years of experience, Gainwell supports agencies and health plans through data-driven innovation, digital modernization, and operational excellence.

The company is known for its commitment to work flexibility, employee development, and inclusive culture. As a Pharmacy Claims Analyst, you’ll be part of a team that values collaboration, continuous learning, and meaningful contributions to healthcare improvement.

Role Overview

Reporting to the Claims Manager, the Pharmacy Post-Payment Claims Analyst is responsible for researching and analyzing pharmacy claims after payment to identify errors, overpayments, and trends. You’ll work with pharmacy data, adjudication systems, and client policies to ensure accuracy and compliance.

This role involves direct communication with pharmacies, development of training materials, operational reporting, and workflow optimization. You’ll also support the design and implementation of new processes and systems to enhance claims management.

Key Responsibilities

• Investigate Ohio Medicaid pharmacy claim overpayments through post-payment audits
• Analyze pharmacy claims for completeness, accuracy, and payment determination
• Develop and update educational documents and workflows for business units
• Create, maintain, and close files in accordance with company policies
• Provide training and guidance to team members on claims and provider issues
• Interpret and analyze data to identify trends and improve revenue cycle efficiency
• Review payer contracts and reimbursement trends to suggest process improvements
• Acquire knowledge of claim adjudication systems, member/provider contracts, and client payment policies
• Respond to client requests and collaborate with internal teams to resolve issues

Required Qualifications

• Bachelor’s degree in business, audit, healthcare, or related field (preferred)
• Minimum of 2 years of experience in claims analysis, processing, benefit configuration, or QA/auditing in healthcare
• Strong understanding of pharmacy claims payment configuration processes and systems
• Proven pharmacy claims processing knowledge
• National certification as a Pharmacy Technician (CPhT)
• Ability to work independently and manage multiple tasks in a remote environment
• Strong analytical, communication, and documentation skills
• Location: Remote (any U.S. city)
• Work Mode: Virtual (Exception only)
• Posted Date: September 12, 2025
• Salary Range: $47,000 – $67,200 per year
• Contract Type: Full-Time, Permanent

Benefits Package

Gainwell offers a comprehensive benefits package for salaried, full-time employees:

• Flexible vacation policy
• 401(k) employer match
• Educational assistance and professional development programs
• Access to leadership and technical development academies
• Inclusive and collaborative work culture
• 100% remote work environment

Why This Role Matters

Pharmacy Claims Analysts are essential to ensuring the integrity of healthcare payment systems. In this role, your work will directly impact the accuracy of Medicaid reimbursements, reduce waste, and support compliance with state and federal regulations.

You’ll be part of a team that values precision, innovation, and continuous improvement—helping to make healthcare work better for everyone.

Who Should Apply

This role is ideal for:

• Certified pharmacy technicians with claims analysis experience
• Healthcare professionals seeking remote work with a mission-driven company
• Candidates with strong analytical and documentation skills
• Individuals passionate about Medicaid operations and pharmacy systems
• Applicants looking for career growth in healthcare technology