Data Analyst III, PBM Business and Operations

July 15

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Rightway

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Healthcare Insurance • SaaS • B2B

Rightway is a healthcare company focused on providing care navigation and pharmacy benefits management solutions. It specializes in helping employers and health systems lower healthcare costs and improve outcomes through personalized, proactive clinical support and transparent pharmacy benefits management. Rightway offers a human-first approach, providing real-time, one-on-one support to members to help them make better healthcare decisions and navigate the complexities of healthcare systems. The company aims to reduce healthcare costs while improving employee satisfaction with healthcare services.

201 - 500 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $100M Series C on 2021-03

📋 Description

• Work cross-functionally with PBM operational teams including Eligibility and Claim Operations, Configuration, and Contact Center to deliver actionable insights and strategic recommendations that support operational goals. • Refine and enhance data infrastructure and processes to improve the scalability and efficiency of PBM services. • Leverage knowledge of PBM practices, adjudication logic, regulatory requirements, and industry trends to guide analytics and decision-making. • Build tools and reporting capabilities to monitor claims and enrollment data for trends, anomalies, or processing variances, enabling operational teams to act on performance improvement opportunities. • Design and maintain dashboards and monitoring solutions to track claims processing metrics, operational KPIs, and performance guarantee compliance. • Create and manage standardized reporting for internal stakeholders and external clients to support daily operations, audits, and client reporting needs. • Apply advanced statistical techniques to assess PBM program performance and build repeatable measures for operational effectiveness. • Develop analytic frameworks and methodologies to support strategic initiatives and enable data-driven operational improvements. • Translate complex data findings into clear, actionable insights using reports, dashboards, and presentations tailored to a range of stakeholders. • Partner with internal teams to identify and evaluate opportunities for AI and automation in PBM operations and support implementation planning.

🎯 Requirements

• Bachelor’s degree in Analytics, Computer Science, or related field, or equivalent work experience. • Proficiency with SQL, relational databases and database structures • Experience in the pharmacy industry and understanding of PBM operations. • Experience with data visualization tools (e.g., Tableau, Power BI, Metabase) • 4-8 years of experience in quantitative analytics and conducting advanced analytic modeling for large pharmacy and clinical datasets. • 5+ years of industry experience querying and analyzing pharmacy claims and clinical program data. • Basic understanding of AI, Generative-AI, and Machine Learning frameworks. • Experience gathering and documenting requirements from clients or the business. • Ability to communicate analysis to business partners and clients both in writing and verbally. • Excellent communication and interpersonal skills. • Experienced with developing data tools, memos, and presentations to deliver data and insights to stakeholders. • Proven ability to guide standards and provide leadership and mentorship to junior team members.

🏖️ Benefits

• Cybersecurity awareness notice • Equal opportunity employer