Pharmacy Pricing Appeals Analyst (PBM Claims)

Capital Rx; New York (NY); Hybrid; USD 56,000 - 72,000; Full time

Job summary

Judi Health seeks a Pharmacy Pricing Appeals Analyst to manage end-to-end intake, review, and processing of pharmacy pricing appeals. You will validate requests, research PBM and claims, review invoices, and document decisions in our tracking systems.

Collaborate with the Manager of Pharmacy Pricing Appeals and cross-functional teams in Analytics, Finance, Compliance, and Network Operations. The role requires attention to detail, claims knowledge, and the ability to handle multiple appeals

Qualifications

• 2–4 years of PBM/pharmacy claims experience
• Associates degree preferred or equivalent experience
• Experience researching and resolving pharmacy claims
• Experience with claims data and invoicing records
• Working knowledge of PBM claims processes
• Advanced Excel skills (filters, sorts, templates)

Responsibilities

• Research pharmacy claim details and document findings
• Compare payment data against invoices and costs
• Understand PBM and pharmacy claims terminology and adjudication
• Communicate clearly with stakeholders and pharmacy contacts
• Maintain audit-ready records

Skills

PBM experience

Pharmacy operations

Pharmacy claims

Data analysis

Excel skills

Education

Associates Degree preferred

Tools

Claims tracking tools

Spreadsheets

Job description

Judi Health seeks a Pharmacy Pricing Appeals Analyst to manage end-to-end intake, review, and processing of pharmacy pricing appeals. You will validate requests, research PBM and claims, review invoices, and document decisions in our tracking systems.

Collaborate with the Manager of Pharmacy Pricing Appeals and cross-functional teams in Analytics, Finance, Compliance, and Network Operations. The role requires attention to detail, claims knowledge, and the ability to handle multiple appeals