[Remote] Senior Pharmacy Data Analyst

Note: The job is a remote job and is open to candidates in USA. WellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for our members. The Senior Pharmacy Data Analyst is responsible for leveraging expertise in pharmacy data analytics to deliver insights that drive operational excellence and member health outcomes.

Responsibilities

• Develop and maintain a centralized dashboard for tracking pharmacy financial, operational, and clinical performance measures
• Lead the process of regulatory reporting from development, validation, and submission collaborating with vendor partners to ensure data accuracy
• Conduct data queries to monitor performance metrics, including Medicare STAR measures and quality improvement initiatives
• Oversee PBM submission of all Part D claims to CMS as PDEs, identifying discrepancies and resolving errors to ensure 100% alignment
• Assume the leadership role of Pharmacy Data Steward, advising cross-functional departments on data exchange specifications and serving as the subject matter expert for pharmacy data integrity
• Support program processes by conducting User Acceptance Testing (UAT) and Quality Assurance (QA) testing
• Collaborate with Pharmacy Department team members to identify, prioritize, and analyze customer needs and requests to include the development and execution of sophisticated data-driven strategies that are closely aligned with the company's overarching mission and strategic objectives
• Communicate effectively with internal cross-functional areas regarding pharmacy programs, formulary management, and pharmacy processes
• Document workflows, perform analysis, and contribute to the design of systems to meet Pharmacy data needs
• Deliver compelling presentations of findings and insights to internal stakeholders, effectively communicating complex concepts in a clear, concise, and persuasive manner using Utilize leading BI tools such as Tableau or Power BI
• Architect and implement intricate data models, data flows, and data integration processes to ensure the accuracy, reliability, and efficiency of data collection, storage, and retrieval mechanisms
• Engage collaboratively with cross-functional teams, including business stakeholders, data scientists, and developers, to identify optimization opportunities and develop innovative, data-driven solutions
• Utilize leading BI tools such as Tableau or Power BI to create dynamic, visually compelling reports and distribute actionable insights effectively
• Harness advanced tools such as Excel (including VBA), Python, or R to manipulate, analyze, and visualize data with precision and sophistication
• Other duties as assigned

Skills

• Bachelor's degree in mathematics, information management, information systems, statistics, or an equivalent combination of education, training, and experience
• Minimum of 5 years of healthcare experience
• Working knowledge of industry coding standards (e.g., generic product indicators, national drug codes, GPI's, etc.)
• Excellent written and verbal communication skills, adept at presenting complex data insights to senior leadership, cross-functional teams, and external partners
• Advanced technical proficiency in Microsoft Excel (pivot tables, advanced formulas, Power Query), with strong proficiency in SQL for data extraction, transformation, and analysis
• Deep understanding of IT and business processes, with proven ability to translate clinical and operational requirements into actionable technical solutions
• Demonstrated ability to influence, consult, and build consensus across multiple stakeholders, driving collaboration between business, IT, and vendor teams
• Strong clinical and operational problem-solving skills with experience in synthesizing large, complex datasets into actionable insights and executive-ready reports
• Proficient in designing, developing, and automating queries, dashboards, and ad hoc reports that support strategic decision-making
• Committed to data integrity, accuracy, and quality, with meticulous attention to detail and validation processes
• Quick to adopt new systems, tools, and analytic approaches, consistently staying ahead of industry trends and best practices
• Ability to organize, synthesize, and analyze large volumes of information
• Skilled at prioritizing multiple initiatives, managing timelines, and delivering high-quality outputs in fast-paced environments
• Detail-oriented with a commitment to producing analytic products of the highest accuracy
• Strong interpersonal skills with a track record of thriving in collaborative, team-based environments
• Master's degree preferred
• Minimum of 10 years in health insurance or with a PBM
• Extensive experience analyzing pharmacy claims data, formulary utilization, and drug cost trends
• Familiarity with Medicare Part D data, STAR measures, and PDE submissions

Benefits

• Full-time remote work
• Competitive salaries
• Excellent benefits
• Benefits (medical, dental, vision, pharmacy)
• Merit increases
• Flexible Spending Accounts
• 403(b) savings matches
• Paid time off
• Career advancement opportunities
• Resources to support employee and family wellbeing

Company Overview