Senior Health Care Analyst

Emergent Holdings•Detroit, MI

4d•$82,900 - $138,800

About The Position

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

Bachelor’s degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or a related field.
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.
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

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.
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.