Position Description:

Capital Blue Cross has an exciting opportunity for a Pharmacy Data Analyst to join our award-winning organization. Since 2014, Capital Blue Cross has scored higher than all health insurance providers publicly measured in the American Customer Satisfaction Index (ACSI) and is proud to be named a Best Places to work in PA, Harrisburg Magazine’s Simply the Best, and Highest Member Satisfaction J.D. Power Award.

The Pharmacy Data Analyst provides data resource consultation and supports data administration with focus on report production, data model development, and analytics within the pharmacy department. Overall, this position is responsible for organizing, implementing, performing, and coordinating various reporting and support functions, including linkages to internal application systems and data warehouse. This individual possesses knowledge of pharmacy claims data, from both the perspective of internal and pharmacy vendor data definitions, along with strong data management skills to serve as data steward to deliver pharmacy business information needs. This position serves as corporate knowledge liaison for the use of pharmacy data between PBM vendor and internal data and reporting business units to support data integrity and information management. Position requires great attention to details along with strong technical aptitude to recognize issues and implement solutions.

Responsibilities and Qualifications:

• Provide support to our Pharmacy Account Management team through timely and accurate reporting analytics with meaningful insight to align with our corporate goal of sustainable pharmacy membership retention, growth and performance. This will be met by ensuring incumbent and prospect employer group’s reporting requests are met through data-driven reporting including, but not limited to: formulary disruption reporting; formulary saving analysis; financial impact of new pharmacy programs; completion of Request for Proposal (RFP) templates and benefit design; impact business process changes; analysis of pharmacy & medical data to design key indicators and outcome measures.
• Provide support to our Pharmacy Operations team through the following: balancing and approval of pharmacy weekly claims invoice; paid and rejected claim reporting derived from our daily MCEF file; quarterly reporting of our PBMs Claims Corrections; ad hoc data support for both our Commercial and Medicare areas.
• Accountable for preparation of reports for internal departmental usage on a routine recurring or ad hoc basis using internal reporting applications and pharmacy vendor reporting software. Perform routine review of pharmacy reporting package provided by pharmacy vendor(s) to ensure accuracy and completeness of deliverables. Develop complete and accurate documentation of reporting methodology on procedures for the collection and use of information to derive performance measures.
• Participate on various projects and project teams as assigned, acting as project lead and assisting staff and management as needed.
• Serve as corporate knowledge liaison for the use of data between PBM vendor and internal application systems and data warehouse. Consult on the development and maintenance of data dictionary, reporting design, and report repository. Serve as pharmacy data steward to support data warehouse activities. Develop and execute pharmacy business test plans, internally and with pharmacy vendor, to ensure compliance with business requirements.

Skills:

• Strong interpersonal and team skills with ability to work and interact externally and internally. Ability to communicate effectively with varied audiences, including ability to lead meetings, develop teamwork, and deliver verbal presentations. Ability to take direction from various levels of staff and perform project work with minimal supervision in a lead or support role.
• Highly competent user of PC operations, applications, and programming languages used (i.e., SAS, Microsoft Office, Microsoft Power BI, EDW, Salesforce, pharmacy reporting software, etc.) gained through formal education and work experience. Demonstrated research, analytical, and logic skills. Strong organizational skills to prioritize and manage workload, multitask, handle rapidly changing priorities to meet stringent deadlines, and manage time effectively. Possess great attention to details along with strong technical aptitude to recognize issues along with problem-solving skills. Ability to manage assigned projects with detailed project plans and methodologies, lead effective work teams, and create innovative solutions that meet or exceed established project objectives. Ability to identify operational and service problems, recommend and implement process enhancements, to increase efficiency and productivity.

Knowledge:

• Knowledge of data analysis concepts and practices at a level required to efficiently run complex queries, perform detailed analysis and develop new databases. Knowledge and experience in pharmacy benefit and prescription drug claims. Familiar with drug utilization management programs (i.e., prior authorization, step therapy, etc.). Understanding of end to end processes and downstream impacts.

Experience:

• Minimum of 1-3 years history in an analytical business environment with specific experience in data and information management, as well as research and analytical support.

Education and Certifications:

• Bachelor’s Degree or equivalent work experience in one of the following: Business Information Management, Business Administration, Mathematics/Statistics, Accounting, or a related healthcare field.

Work Environment:

Remote Work

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.

Other:

• Key Interfaces: IT&D, A&R, Finance, PBM

About Us: Capital Blue Cross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for over 80 years, Capital Blue Cross offers employees excellent pay, bonus opportunities, benefits, health and wellness incentives, opportunities for career advancement and community involvement, and work-life balance. In return, every member of our workforce plays an important part in something much bigger: working together and making a difference every day to improve the health and well-being of our members and the communities in which they live.