Senior Health Care Analyst

SUMMARY:   

The Senior Health Care Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments.  This position operates within broad objectives to ensure optimum utilization of manpower and budget.  This role researches, compiles, and analyzes appropriate and relevant data and makes recommendations for operational improvements. 

RESPONSIBILITIES/TASKS: 

• Support PBM transition tasks and participate in workstream meetings
• Supports PBM audit and analytics to support Medicare pharmacy services business team. 
• Builds and supports business reports to be included in executive dashboard.
• Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.
• Possesses and maintains an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles and methodologies.
• Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
• Develops lines of communication to discuss and review results of analysis to management via reports and presentations and assists management in implementing programs that provide solutions.
• Investigates, reviews, recommends, communicates, and implements solutions which identify problems/root cause of issues. 
• Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.
• Independently develops and plans reports, papers, and/or other materials in a clear and concise manner.
• Provides expertise and guidance to unit and corporate staff as required.
• Acts as a liaison between corporate business areas and participates in group or committee discussions. 
• Interacts with pharmacy functional business owners to define measurable metrics and assists them to use the dashboard on a daily basis. 
• Supports ongoing maintenance of executive dashboard and related products, applications, and platforms. 
• Works with analytics business analysts/developers and operations personnel to automate dashboard functions. 

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor’s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or a related field.  Master’s degree in a related field is preferred.  Relevant combination of education and experience may be considered in lieu of degree.  Continuous learning, as defined by the Company’s learning philosophy, is required.  Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE: 

Seven years 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).

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Strong experience in implementing new PBM and transitioning the plan business functions from current PBM to new PBM 
• Knowledge of PBM systems and tools.
• Excellent analytical, planning, problem solving, verbal, and written skills to communicate complex ideas.
• Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
• 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.

Department Summary / Preferences:

- Ability to quality check and support Plan Finder file submissions to HPMS within CMS defined windows
- Ability to produce Plan Finder accuracy reports as per CMS guidance

- Support Pharmacy claim utilization dashboards
- Support Pharmacy Utilization Data Quality Triage 

- Minimum 4 years of experience with PBM claim processing system

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. 

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. 

PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic l