Emblem Health Hiring for Senior Analyst- Pharm. Analytics at New York Full Time

Summary of Position

Provide statistical analysis of pharmacy-related data, functioning as a partner to actuarial, finance medical economics,
medical management and network for well-informed decision-making.
Produce creative and insightful approaches to information analysis and management, allowing leadership to draw conclusions
about the performance of drugs, products, providers, partners and clinical programs.
Support the enterprise in pharmacy trend analytics.
Support rebate and PDE functions effectively across the enterprise.
Perform operational analytics, using data analytics tools efficiently to inform the business in support of strategic decision
making, measuring the effectiveness of program implementations.
Assist with the evaluation of contractual terms with PBM.

Principal Accountabilities

Provide continual support to the monthly pharmacy trend and analytics processes.
Ensure quality and accuracy of rebate data.
Support the delivery of the annual and re-stated DIR reports for two plan years concurrently.
Responsible for maintaining databases for easy reporting solutions.
Assume responsibility for personal and professional development.
Perform other duties related to pharmacy analytics as assigned or required. 25%
Work with counterparts in the pharmacy team and Express Scripts to address areas of concern.
Provide valuation and evaluations related to Rx HCCI initiatives.
Track and monitor the results of implemented Rx HCCI for internal validation.
Assess PBM financial performance guarantees and track performance against the guarantees.
Validate PBM estimates of new pharmacy initiatives.
Use audit tools and data analytics to validate accuracy of the DIR report.
Interface with CMS on DIR submissions, attestation and any follow up required.
Provide assistance with Medicare Prescription Data Event (PDE).
Work with the ESI PDE team on prioritization of PDE reject resolution.
Monitor ESI performance to ensure conformance to CMS guidance.
Create and maintain a user-friendly PDE dashboard to inform management of revenue secured through accurate, timely PDE processing.

Education, Training, Licenses, Certifications

Bachelor’s degree in Analytics, Economics, Mathematics, Pharmacy, or related field of study.

Relevant Work Experience, Knowledge, Skills, and Abilities

4 – 6 years of relevant, professional work experience. (R)
3 – 5 years of health insurance experience in an analytical role. (R)
Solid understand of both medical and pharmacy claims data. (R)
Advanced understanding of analytical principles and methodologies. (R)
In-depth knowledge of the Health Insurance industry. (R)
Excellent mathematical and analytical skills. (R)
Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience. (R)
Proficient with MS Office (Word, Excel, Powerpoint, Teams, Outlook) (R)
Advanced SAS knowledge. (R)
Experience working closely with business leaders. (R)

Additional Information

– Requisition ID: 1000000600_01

Equal Opportunity Employer – minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity