Claims Business Analyst — Pharmacy

Job overview

The Claims Business Analyst — Pharmacy role is listed in United, WV; the posting does not specify whether the work is onsite, hybrid, or remote, and compensation is not specified. The analyst works with the Director of Claims to support timely, accurate claim payments and first-call resolution. The role connects technology capabilities with business objectives by analyzing, building, testing, and deploying product features and operational tools. It supports claims and call-center performance through reporting, data validation, workflow improvements, and recommendations intended to improve quality, reduce claim inventory, and enhance customer experience.

What you'll do

• Help develop claim-processing and call-center performance indicators
• automate work distribution and maintain metric dashboards
• generate and distribute departmental reports
• identify data trends and communicate findings and recommendations
• refine tools with managers and subject matter experts
• define and validate data, retrieve and merge data from multiple sources, review technical documentation, configure reports, and coordinate project efforts
• liaise with other departments on reporting and system changes
• document business requirements and user journeys
• collaborate across the product team.

What we're looking for

Skills & competencies

claims business analyst

pharmacy claims

claims processing

call center metrics

data analysis

dashboards

reporting

microsoft excel

icd-10

cpt-4

medicare part d

medicaid

ncpdp

hipaa

Work arrangement

• Weekend coverage required

Why this role

The posting seeks experience in pharmacy claims processing and managed care, including payer/PBM markets, Medicare and Medicaid Part D, NCPDP standards, and HIPAA regulations; it states that sponsorship is unavailable.

About the employer

Forhyre is hiring for this role. Industry: Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds. Sector: 52.