Senior Analyst- Pharmacy Analytics - Emblem Health

• Provide statistical analysis of pharmacy-related data, functioning as a partner to actuarial, finance medical economics,
medical management and network for well-informed decision-making.
• Produce creative and insightful approaches to information analysis and management, allowing leadership to draw conclusions
about the performance of drugs, products, providers, partners and clinical programs.
• Support the enterprise in pharmacy trend analytics.
• Support rebate and PDE functions effectively across the enterprise.
• Perform operational analytics, using data analytics tools efficiently to inform the business in support of strategic decision
making, measuring the effectiveness of program implementations.
• Assist with the evaluation of contractual terms with PBM.

Principal Accountabilities

• Provide continual support to the monthly pharmacy trend and analytics processes.
• Ensure quality and accuracy of rebate data.
• Support the delivery of the annual and re-stated DIR reports for two plan years concurrently.
• Responsible for maintaining databases for easy reporting solutions.
• Assume responsibility for personal and professional development.
• Perform other duties related to pharmacy analytics as assigned or required. 25%
• Work with counterparts in the pharmacy team and Express Scripts to address areas of concern.
• Provide valuation and evaluations related to Rx HCCI initiatives.
• Track and monitor the results of implemented Rx HCCI for internal validation.
• Assess PBM financial performance guarantees and track performance against the guarantees.
• Validate PBM estimates of new pharmacy initiatives.
• Use audit tools and data analytics to validate accuracy of the DIR report.
• Interface with CMS on DIR submissions, attestation and any follow up required.
• Provide assistance with Medicare Prescription Data Event (PDE).
• Work with the ESI PDE team on prioritization of PDE reject resolution.
• Monitor ESI performance to ensure conformance to CMS guidance.
• Create and maintain a user-friendly PDE dashboard to inform management of revenue secured through accurate,timely PDE processing.

Education, Training, Licenses, Certifications

• Bachelor's degree in Analytics, Economics, Mathematics, Pharmacy, or related field of study.

Relevant Work Experience, Knowledge, Skills, and Abilities

• 4 - 6+ years of relevant, professional work experience. (R)
• 3 - 5+ years of health insurance experience in an analytical role. (R)
• Solid understand of both medical and pharmacy claims data. (R)
• Advanced understanding of analytical principles and methodologies. (R)
• In-depth knowledge of the Health Insurance industry. (R)
• Excellent mathematical and analytical skills. (R)
• Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience. (R)
• Proficient with MS Office (Word, Excel, Powerpoint, Teams, Outlook) (R)
• Advanced SAS knowledge. (R)
• Experience working closely with business leaders. (R)

Additional Information

• Requisition ID: 1000000600_01