Health Data Analyst – Pharmacy Claims Audit

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📉 Data Analyst

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Provide information, analyses, and consultation to internal and external stakeholders • Assess pharmacy benefit and/or network performance and develop recommendations for improvement or enhancement • Analyze and interpret client pharmacy benefit data, trends, and reports • Partner with the analytics team to deliver recommendations or project status updates • Investigate follow-up items, questions, and key drivers of benefit performance • Create SAS Enterprise Guide queries with multiple table joins, table-structure analysis, and detailed formulas using SAS code • Participate in developing analytic methodologies, models, reports, products, and benefit programs • Perform Centers for Medicaid/Medicare Services reporting and analysis, including directory management and bid support • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Mathematics, Finance, or related field, or equivalent combination of education and/or relevant work experience • High school diploma or GED required • 2 years of experience in pharmacy benefits management, reporting and analytics, benefits consulting, healthcare, financial services, or related field • Must be eligible to work in the United States without work visa or residency sponsorship • Advanced Microsoft Excel skills, including complete formulas and efficient data manipulation • Extensive experience using analytic tools; familiarity with Alteryx and Cognos • Experience with pharmacy audit and/or fraud, waste, and abuse • Intermediate troubleshooting skills and in-depth client data research • Strong PBM industry knowledge and ability to explain industry trends and their impact on client financials • Ability to establish rapport and influence at all organizational levels • Ability to communicate effectively and present complex data to varied audiences • Knowledge of PBM data and metrics such as PMPM and generic utilization • Experience working with large pharmacy, claims, medical, and/or financial datasets • Previous client-facing or consultative experience preferred • Familiarity with SAS Enterprise Guide preferred • Ability to perform essential job functions, with reasonable accommodations available if requested • Must comply with job-specific security responsibilities, applicable legal, regulatory, contractual requirements, and internal policies

🏖️ Benefits

• Benefits, incentives, and additional compensation are provided; the posting directs applicants to Prime’s Benefits Page for details • Equal opportunity and affirmative action employer • Reasonable accommodations for applicants with disabilities • Tobacco-Free Workplace