Senior Health Care Analyst - Pharmacy

This position supports Medicare Part D pharmacy quality and medication adherence initiatives through data analysis, reporting, dashboard development, and operational support.

Responsibilities

• Analyze healthcare data, monitor quality measures, and provide actionable insights to business and clinical partners.
• Support initiatives that improve CMS Star Ratings.
• Support PBM transition tasks and participate in workstream meetings.
• Support PBM audit and analytics to assist the Medicare pharmacy services business team.
• Build and support business reports for inclusion in executive dashboards.
• Lead research, analysis, identification, and evaluation of data to assess existing and potential trends and issues.
• Maintain comprehensive knowledge of BCBSM business, products, programs (including provider data, networks), corporate organizational structure, and research methodologies.
• Manage and monitor multiple projects simultaneously, establishing project plans and objectives to ensure goal attainment.
• Develop communication lines to review analysis results with management and assist in implementing solution-driven programs.
• Investigate, review, recommend, and implement solutions to identify problems and root causes of issues.
• Identify and resolve challenges to fulfill key corporate objectives, responding to change management demands and initiating necessary actions.
• Independently develop and plan reports, papers, and materials in a clear, concise manner.
• Provide expertise and guidance to unit and corporate staff as required.
• Act as a liaison between corporate business areas and participate in group or committee discussions.
• Interact with pharmacy functional business owners to define measurable metrics and assist in daily dashboard usage.
• Support ongoing maintenance of executive dashboards and related products, applications, and platforms.
• Collaborate with analytics business analysts/developers and operations personnel to automate dashboard functions.

Requirements

• Strong experience developing complex SQL queries and analyzing large healthcare datasets, including pharmacy claims, medical claims, membership, and provider data.
• Proficiency in Python for healthcare analytics, reporting, process automation, and data quality validation.
• Experience writing and maintaining Spark SQL and Python code in Databricks for process automation and data analytics.
• Familiarity with SAS programming for data manipulation, reporting, and analytics.
• Strong Tableau experience in developing interactive dashboards and self-service analytics solutions for deep-dive analysis.
• Experience monitoring medication adherence, drug trend analysis, provider and retail pharmacy performance, program/cohort evaluations, and intervention outcomes.
• Ability to investigate data quality issues, validate CMS measure calculations, and resolve member-level discrepancies.
• Strong analytical, problem-solving, communication, and collaboration skills, with the ability to translate complex data into actionable business insights.
• Strong experience implementing new PBM and transitioning plan business functions from current PBM to new PBM.
• Knowledge of PBM systems and tools.
• Excellent analytical, planning, problem-solving, verbal, and written communication skills.
• Proficiency in software packages such as PowerPoint, Excel, and Word.
• CMS reporting, Medicare data reporting, claims data reporting, and enrollment data reporting preferred.
• Ability to work independently, within a team environment, and communicate effectively with employees at all levels.

Qualifications

• Bachelor’s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or a related field. Master’s degree preferred.
• Relevant combination of education and experience may be considered in lieu of degree.
• Seven years of experience in a related field, typically in two subject areas (e.g., financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.

Pay

Actual compensation relies on consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. A reasonable estimate for this role is between $82,900 and $138,800.