California Physicians' Service-posted about 1 year ago
$118,800 - $178,200/Yr
Full-time • Senior
Remote • Oakland, CA
Insurance Carriers and Related Activities

The Medical Informatics Analyst, Consultant at Blue Shield of California plays a crucial role in the Data & Analytics (D&A) team, partnering with business stakeholders to leverage data and analytics for improved business outcomes. This position focuses on pharmacy analytics, requiring expertise in pharmacy claims data and the ability to translate business needs into analytical solutions. The role emphasizes leadership, collaboration, and the development of high-performing teams to drive results and foster continuous learning.

  • Partner with Pharmacy Services team as a data analytics subject matter expert to address data needs to support pharmacy operational, strategic and compliance needs.
  • Design, develop and lead analytical solutions for Pharmacy Care Reimagined programs.
  • Provide pharmacy and prescription drug data expertise to cloud migration teams.
  • Implement data quality rules necessary to ensure timely and accurate delivery of reports.
  • Perform data exploration using statistical programming languages (including R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques.
  • Support cost of health care pharmacy analyses to assist in the development of complex cost of health care formulations.
  • Support development of budget/trend impact models and formulary strategy models for high impact pharmacy initiatives.
  • Work closely with stakeholders on report development and automation, in-depth drill down on report reconciliations, research, and development of rebate allocation methodologies.
  • Lead research and development of new analyses, operation process improvement, and internal quality control.
  • Evaluate analytic results, prepare presentation materials, and make recommendations to inform effective decision-making.
  • Review, update, and enhance existing analytic processes to improve efficiency and quality.
  • Manage large sized projects (or multiple projects) spanning across business areas.
  • Oversee projects and provide training and mentoring for team members on best practices for analysis and reporting.
  • Consult and make recommendations to senior management/executives on significant issues.
  • Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience.
  • Requires at least 7 years of prior relevant experience and 5 years of experience in Health Care (pharmacy, managed care, academic, or government payer).
  • SAS certification or equivalent experience required.
  • Demonstrated critical-thinking, analytical, and thought leadership skills.
  • Experience in translating business problems into analytical approaches.
  • Current working knowledge of SQL and Excel strongly preferred.
  • Tableau experience strongly preferred.
  • Python experience preferred.
  • Previous project management experience preferred.
  • Experience with machine learning techniques.
  • Familiarity with cloud migration processes.
  • Work from home
  • Health insurance
  • 401k
  • Paid holidays
  • Professional development opportunities
  • Flexible scheduling
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