Milliman
Senior Pharmacy Benefits Claims Analyst
Milliman, San Diego, California, United States, 92189
Overview
We are looking for a Senior Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. Who We Are This full-time position is for the pharmacy benefits consulting team within Milliman’s San Diego Health Practice, which primarily serves plan sponsors that have contracted with PBMs to provide pharmacy benefits. The team helps plan sponsors navigate the evolving healthcare landscape by providing timely and thorough analysis, empowering our clients to make critical decisions impacting prescription drug affordability and access. What You Will Do
We are looking for a Senior Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. Key responsibilities will include the following : Design and conduct data-driven analyses using pharmacy claims data and complex modeling. Participate actively as a member of a multi-disciplinary analytics team, fostering the sharing of relevant information to help identify creative solutions to complex problems. Explain results of analyses to internal teams and provide valuable insights, both orally and in clear, concise client reports. Stay current on industry trends, regulations, and best practices in pharmacy benefit management. Contribute to the development of innovative methodologies and tools for pharmacy claims analytics. What We Are Looking For
Professional Qualifications Minimum of 10 years PBM or healthcare analytics experience, including at least 5 years of experience specific to PBM analytics. Working knowledge of Microsoft Office suite, including proficiency in Excel and SQL Server. Proficiency working with and explaining movements in key PBM performance indicators and pharmacy claims statistics. Knowledge of formularies, pharmacy claims data and their nomenclatures, including NDC, AWP, PBM, WAC, etc. Knowledge of claims data and how these manifest in claim adjudication and downstream analyses. Personal Qualifications Strong time management and people management skills. Experience working in a dynamic environment, demonstrating adaptability and integrity. Strong technical communication skills, written and oral. Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in the future. The Team
The San Diego Health practice includes employees with diverse areas of experience and expertise in the pharmacy space. Current employees include those that have worked as actuaries, PBM analysts / consultants, pharmacists, and pharmacy technicians. Location
This role is based out of the Milliman office in San Diego, California, but candidates hired into this role may work remotely anywhere in the US. The expected application deadline for this job is August 15, 2025. Compensation
The overall salary range for this role is $85,100 - $168,600. For candidates residing in : Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, Pennsylvania, Virginia, Washington, or the District of Columbia the salary range is $93,610 - $154,550. New York City, Newark, San Jose, or San Francisco the salary range is $102,120 - $168,600. All other locations the salary range is $85,100 - $140,500. A combination of factors will be considered, including, but not limited to, education, relevant work experience, qualifications, skills, certifications, etc. Benefits
We offer a comprehensive benefits package designed to support employees’ health, financial security, and well-being. Benefits include : Medical, Dental and Vision – Coverage for employees, dependents, and domestic partners. Employee Assistance Program (EAP) – Confidential support for personal and work-related challenges. 401(k) Plan – Includes a company matching program and profit-sharing contributions. Discretionary Bonus Program – Recognizing employee contributions. Flexible Spending Accounts (FSA) – Pre-tax savings for dependent care, transportation, and eligible medical expenses. Paid Time Off (PTO) – Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis. Holidays – A minimum of 10 paid holidays per year. Family Building Benefits – Includes adoption and fertility assistance. Paid Parental Leave – Up to 12 weeks of paid leave for employees who meet eligibility criteria. Life Insurance & AD&D – 100% of premiums covered by Milliman. Short-Term and Long-Term Disability – Fully paid by Milliman. Equal Opportunity All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, national origin, disability, or status as a protected veteran.
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We are looking for a Senior Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. Who We Are This full-time position is for the pharmacy benefits consulting team within Milliman’s San Diego Health Practice, which primarily serves plan sponsors that have contracted with PBMs to provide pharmacy benefits. The team helps plan sponsors navigate the evolving healthcare landscape by providing timely and thorough analysis, empowering our clients to make critical decisions impacting prescription drug affordability and access. What You Will Do
We are looking for a Senior Pharmacy Benefits Claims Analyst for our growing practice. Pharmacy benefits consulting work is, by nature, constantly changing and rarely routine. Applicants must have a deep understanding of pharmaceuticals and pharmacy benefits management (PBM) and feel comfortable working in an environment that requires attention to detail, collaboration, integrity, and adaptability. Key responsibilities will include the following : Design and conduct data-driven analyses using pharmacy claims data and complex modeling. Participate actively as a member of a multi-disciplinary analytics team, fostering the sharing of relevant information to help identify creative solutions to complex problems. Explain results of analyses to internal teams and provide valuable insights, both orally and in clear, concise client reports. Stay current on industry trends, regulations, and best practices in pharmacy benefit management. Contribute to the development of innovative methodologies and tools for pharmacy claims analytics. What We Are Looking For
Professional Qualifications Minimum of 10 years PBM or healthcare analytics experience, including at least 5 years of experience specific to PBM analytics. Working knowledge of Microsoft Office suite, including proficiency in Excel and SQL Server. Proficiency working with and explaining movements in key PBM performance indicators and pharmacy claims statistics. Knowledge of formularies, pharmacy claims data and their nomenclatures, including NDC, AWP, PBM, WAC, etc. Knowledge of claims data and how these manifest in claim adjudication and downstream analyses. Personal Qualifications Strong time management and people management skills. Experience working in a dynamic environment, demonstrating adaptability and integrity. Strong technical communication skills, written and oral. Individual(s) must be legally authorized to work in the United States without the need for immigration support or sponsorship from Milliman now or in the future. The Team
The San Diego Health practice includes employees with diverse areas of experience and expertise in the pharmacy space. Current employees include those that have worked as actuaries, PBM analysts / consultants, pharmacists, and pharmacy technicians. Location
This role is based out of the Milliman office in San Diego, California, but candidates hired into this role may work remotely anywhere in the US. The expected application deadline for this job is August 15, 2025. Compensation
The overall salary range for this role is $85,100 - $168,600. For candidates residing in : Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, Pennsylvania, Virginia, Washington, or the District of Columbia the salary range is $93,610 - $154,550. New York City, Newark, San Jose, or San Francisco the salary range is $102,120 - $168,600. All other locations the salary range is $85,100 - $140,500. A combination of factors will be considered, including, but not limited to, education, relevant work experience, qualifications, skills, certifications, etc. Benefits
We offer a comprehensive benefits package designed to support employees’ health, financial security, and well-being. Benefits include : Medical, Dental and Vision – Coverage for employees, dependents, and domestic partners. Employee Assistance Program (EAP) – Confidential support for personal and work-related challenges. 401(k) Plan – Includes a company matching program and profit-sharing contributions. Discretionary Bonus Program – Recognizing employee contributions. Flexible Spending Accounts (FSA) – Pre-tax savings for dependent care, transportation, and eligible medical expenses. Paid Time Off (PTO) – Begins accruing on the first day of work. Full-time employees accrue 15 days per year, and employees working less than full-time accrue PTO on a prorated basis. Holidays – A minimum of 10 paid holidays per year. Family Building Benefits – Includes adoption and fertility assistance. Paid Parental Leave – Up to 12 weeks of paid leave for employees who meet eligibility criteria. Life Insurance & AD&D – 100% of premiums covered by Milliman. Short-Term and Long-Term Disability – Fully paid by Milliman. Equal Opportunity All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, national origin, disability, or status as a protected veteran.
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