Senior Health Care Analyst - Pharmacy

Blue Cross Blue Shield of Michigan•Detroit, MI

About The Position

This position supports Medicare Part D pharmacy quality and medication adherence initiatives through data analysis, reporting, dashboard development, and operational support. Responsibilities include analyzing healthcare data, monitoring quality measures, providing actionable insights to business and clinical partners, and supporting initiatives that improve CMS Star Ratings. 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.

Requirements

Strong experience developing complex SQL queries and analyzing large healthcare datasets, including pharmacy claims, medical claims, membership, and provider data.
Proficiency in Python for healthcare analytics, reporting, process automation, and data quality validation.
Experience in writing and maintaining Spark SQL and Python code in Databricks to support process automation and data analytics
Familiarity with SAS programming for data manipulation, reporting, and analytics.
Strong Tableau experience in developing interactive dashboards and self-service analytics solutions for deep-dive analysis.
Experience in monitoring medication adherence, drug trend analysis, provider and retail pharmacy performance, program/cohort evaluations, and intervention outcomes.
Ability to investigate data quality issues, validate CMS measure calculations, and resolve member-level discrepancies.
Strong analytical, problem-solving, communication, and collaboration skills, with the ability to translate complex data into actionable business insights.
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.
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).
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.).
Ability to work independently, within a team environment, and communicate effectively with employees at all levels.

Nice To Haves

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.
CMS reporting, Medicare data reporting, claims data reporting, and enrollment data reporting preferred.

Responsibilities

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.
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.