Health Data Analyst (Pharmacy Claims Audit) - Remote

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Job Description

The Health Data Analyst provides information, analyses, and consultation to internal and external stakeholders. This position assesses the performance of pharmacy benefits and/or networks and develops recommendations for improvements or enhancement to support departmental and organizational objectives. This position will participate in the development of new reports, analytical models, and products/benefit programs that align with Prime's strategic imperatives.

Responsibilities

• Assumes responsibility for moderately complex analytic and consultative work such as analyzing and interpreting client pharmacy benefit data, trends and reports and partnering with analytics team to deliver recommendations or project status updates to internal and external stakeholders; investigates follow up items or questions regarding project and/or request scope
• Investigates key drivers of benefit performance
• Create new queries using SASEG including multiple table joins, understanding of table structures, creation of detailed formulas leveraging an understanding of SAS code
• Participates in development of analytic methodologies, models, reports and new products
• May be responsible for Centers for Medicaid/Medicare Services reporting and analysis, including the management of directories and bid support
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in Mathematics, Finance, or related field, or the equivalent combination of education and/or relevant work experience; HS diploma or GED is required

• 2 years of experience in pharmacy benefits management, reporting & analytics, benefits consulting, healthcare, financial services or related field
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Advanced Microsoft Excel skills – ability to create complete formulas and efficient data manipulation.
• Extensive experience using analytic tools; familiarity with Alteryx and Cognos
• Experience working with pharmacy audit and/or fraud waste, and abuse
• Intermediate troubleshooting skills, including in-depth client data research, which may involve research and drivers of utilization; understands resources needed and steps/processes on how to complete the problem; able to understand when an issue arises how-to navigate to a resolution
• Strong PBM industry knowledge; able to articulate the industry trends to clients and the impact of trends and changes to client financials
• Ability to establish rapport and effectively influence at all levels within an organization
• Ability to communicate effectively and present complex data to a wide variety of audiences

Preferred Qualifications

• Knowledge of the PBM (Pharmacy Benefit Management) industry and PBM data; understands key PBM metrics (such as PMPM, generic utilization)
• Experience working with large sets of pharmacy, claims, medical, and/or financial data
• Previous experience in a client facing or consultative role
• Extensive experience using analytic tools; familiarity with SAS EG

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.