Health & Pharmacy Analytics Lead, Human Resources

Key Responsibilities

• Analyze medical, pharmacy, behavioral health, and vendor data to identify utilization trends, cost drivers, risk factors, and population needs.
• Build predictive models (e.g., high-risk identification, chronic disease progression, utilization forecasting) using available plan data assets.
• Conduct cost-of-care studies to evaluate financial impact of clinical programs, pharmacy initiatives, plan design changes, and vendor performance.
• Utilize data ranging from claim-level detail to longitudinal trend analysis to support decision-making.
• Explore and evaluate emerging analytics technologies, including AI-enabled tools, to enhance reporting, forecasting, data interpretation, and decision support capabilities.
• Develop and maintain dashboards for leadership, including KPIs related to medical spend, pharmacy spend, quality, utilization, and outcomes.
• Produce recurring reports for executive leadership, governance committees, auditors, actuaries, and HR partners.
• Translate complex data into clear, digestible visualizations and narratives for both technical and non-technical audiences.
• Oversee data integrity, validation processes, and reconciliation across multiple sources (TPA, PBM, consultant partner, wellness partner, university systems).
• Ensure alignment with data security, privacy, and HIPAA standards.
• Collaborate with vendor partners to optimize data interfaces, refresh schedules, and architecture.
• Support Clinical Programs with actionable clinical insights (e.g., gap-in-care reports, chronic condition stratification, evaluation of interventions).
• Partner with TPA and UVA Pharmacy leadership on drug utilization reviews, specialty trend analyses, and biosimilar opportunity modeling.
• Partner with consultants to support forecasting, budget analysis, and actuarial activities.

Minimum Qualifications

• Bachelor’s degree or equivalent combination of related experience.
• Certified Health Data Analyst (CHDA) credential preferred; candidates with comparable healthcare analytics experience are encouraged to apply.
• Eight years of progressive experience in healthcare analytics, pharmacy analytics, population health, health plan operations, actuarial support, healthcare consulting, benefits analytics, or related analytical roles involving interpretation of healthcare claims, utilization, coding, and cost data to support reporting, forecasting, and decision-making.

Preferred Qualifications

• Experience in analyzing medical and pharmacy claims data, dental claims, utilization trends, healthcare costs, and population health outcomes.
• Working knowledge of interpreting standardized code sets that represent medical, surgical, dental and diagnostic services.
• Demonstrated ability to translate complex healthcare, pharmacy, and operational data into actionable insights and effectively communicate findings to executive leaders, technical teams, and non-technical stakeholders.
• Demonstrated experience developing dashboards, reports, KPIs, and executive-level analytics using Artemis by Naomi Health and/or comparable healthcare analytics platforms.
• Strong analytical and quantitative skills, including experience with forecasting, trend analysis, predictive modeling, and financial impact analysis.
• Demonstrated ability and willingness to leverage emerging technologies, including AI-enabled analytics and reporting tools, to improve data analysis, decision-making, and operational efficiency.
• Experience working with healthcare data sources such as TPAs, PBMs, wellness vendors, EMRs/EHRs, or university/health system data environments.
• Knowledge of healthcare reimbursement methodologies, claims adjudication, medical coding concepts, and pharmacy utilization management practices.
• Experience collaborating cross-functionally with leadership teams, clinical leaders, finance teams, operational stakeholders, consultants, and external vendors.
• Knowledge of HIPAA, healthcare privacy regulations, and data governance best practices.
• Demonstrated ability to work independently while also serving as a strategic thought partner to leadership.