WellSense Health Plan ยท 3 days ago
Senior Pharmacy Data Analyst
United States
Full-time
Remote
Mid, Senior Level
$77K/yr - $112K/yr
5+ years expWellSense 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 plays a critical role in advancing the strategic objectives of the Pharmacy Department by leveraging expertise in pharmacy data analytics to deliver actionable insights that drive operational excellence and member health outcomes.
Hospital & Health Care
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
Qualification
Required
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
Successful completion of pre-employment background check
Preferred
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
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
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
H1B Sponsorship
WellSense Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (8)
2023 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase