Pharmacy Claims Analytics Lead

Judihealth; Charlotte, Denver, New York (NC, CO, NY); Hybrid; USD 111,000 - 157,000; Full time

Job summary

Judi Health in Charlotte, NC is seeking a highly analytical Analyst to join our Analytics team to support pharmacy claims integrity, adjudication validation, and operational excellence. This role uses SQL and large-scale pharmacy claims data to investigate outcomes, identify discrepancies, validate benefit configurations, and ensure claims adjudicate accurately.

You will collaborate with Finance, Legal, Product, Operations, Network, and Compliance to drive audits, quantify impact, and implement

Qualifications

• 4–6 years of experience in healthcare analytics or PBM operations.
• Advanced SQL skills to analyze large datasets.
• Experience with pharmacy reimbursement, network pricing and financial reconciliation.
• Ability to translate complex pricing terms into documented calculations.
• Experience identifying discrepancies across claims and adjudication logic.
• Proven ability to quantify financial exposure and communicate findings to leadership.

Responsibilities

• Analyze and validate pharmacy claims and adjudication outcomes.
• Investigate pricing, benefit application, and reimbursement calculations for discrepancies.
• Develop repeatable monitoring to identify anomalies and risks.
• Partner with Finance, Legal, Product, Operations, Network, and Compliance to interpret requirements.
• Prepare documentation of methodologies and remediation activities.

Skills

Advanced SQL

Healthcare analytics

Pricing terms

Data interpretation

Auditing analytics

Stakeholder comms

Job description

Judi Health in Charlotte, NC is seeking a highly analytical Analyst to join our Analytics team to support pharmacy claims integrity, adjudication validation, and operational excellence. This role uses SQL and large-scale pharmacy claims data to investigate outcomes, identify discrepancies, validate benefit configurations, and ensure claims adjudicate accurately.

You will collaborate with Finance, Legal, Product, Operations, Network, and Compliance to drive audits, quantify impact, and implement