Health Informatics Sr Analyst

Prime Therapeutics•Home, WV

7d•$94,000 - $160,000

About The Position

The Health Informatics Analyst Sr leads advanced data initiatives that support clinical programs, cost containment strategies, and operational effectiveness. The role partners with cross-functional teams—including clinical services, pharmacy operations, product management, and client services—to transform complex healthcare data into actionable insights. It applies advanced statistical, analytic, and business acumen while championing evidence-based decision-making, regulatory compliance, and improved patient and business outcomes.

Requirements

Bachelor’s degree in Health Informatics, Public Health, Computer Science, Data Science, Statistics, or a related area, or an equivalent combination of education and/or relevant work experience; high school diploma or equivalent GED is required.
Five years of work experience in healthcare data analytics, including at least three years in the PBM or managed care environment.
Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Knowledge of and ability to analyze data using Tableau, Qlik, Power BI, or similar platforms.
Advanced knowledge of pharmacy claims data, drug classifications, formulary management, and rebate processes.
Ability to work under tight deadlines in a highly dynamic environment.
Strong knowledge of pharmacy benefit structures, drug pricing, and claims processing.
Demonstrated competency in developing efficient and effective solutions to complex business problems.
Familiarity with drug coding systems (NDC) and medical coding (ICD, CPT, HCPCS).
Must understand, comply with, and attest to the security responsibilities and controls unique to the job, and comply with applicable legal, regulatory, contractual, and internal requirements.
Must be able to perform the essential functions of the job; reasonable accommodations will be made for employees with disabilities upon request, absent undue hardship.

Nice To Haves

Experience manipulating and analyzing healthcare medical and pharmacy claims data.
Experience with transact-SQL (MS SQL or Oracle).
Experience with SQL, GCP, Python, or SAS for data extraction and analysis.
Experience with clinical decision support systems.
Certifications such as Certified Health Data Analyst (CHDA) or PMP.
Master’s degree in Health Informatics, Public Health, Computer Science, Data Science, Statistics, or a related field.

Responsibilities

Analyze large-scale healthcare claims, eligibility, provider, and clinical data to identify trends, address business needs, and inform organizational strategies.
Design, develop, and deliver advanced regular and ad-hoc reports for pricing, risk evaluation, medication adherence, formulary compliance, and utilization management.
Partner with stakeholders and lead development of forecasting models, predictive indicators, and statistical analyses to measure program compliance and improve outcomes.
Lead the design, validation, and automation of dashboards and visualizations, ensuring scalability and regulatory alignment.
Provide data-driven recommendations for formulary design, prior authorization criteria, and drug utilization review (DUR) programs.
Partner with leadership to define issues, select analytic methodologies, and interpret complex data for executive decision-making.
Mentor and guide Analysts, providing technical leadership and ensuring alignment with best practices and evolving industry standards.
Perform other duties as assigned.