GalaxE.Solutions · 4 hours ago
Plan Design Analyst
United States
Full-time
Remote
Entry, Mid Level
2+ years exp
Maximize your interview chancesAppsArtificial Intelligence (AI)
Hiring Manager
Allan Ingraham
Insider Connection @GalaxE.Solutions
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Responsibilities
Gather and compile pharmacy and healthcare-related data from various sources, including claims, prescriptions, and pharmacy networks, ensuring comprehensive data capture.
Ensure data accuracy, completeness, and consistency through rigorous validation and cleaning processes to maintain high data quality standards.
Apply statistical and analytical techniques to identify trends, patterns, and anomalies in pharmaceutical claim data, providing actionable insights to support decision-making.
Perform cost-benefit analysis and cost-effectiveness studies for different medication and treatment options, helping to optimize financial and clinical outcomes.
Create reports, dashboards, and visualizations using tools like Domo, Tableau, or Power BI, effectively conveying insights and findings to various stakeholders, including senior leadership and cross-functional teams.
Compare data from different time periods and between different types of customers to better assess which plan actions are working and to what degree.
Utilize predictive modeling and forecasting techniques to project future pharmacy benefit program costs and utilization patterns, aiding in strategic planning and budgeting.
Assess the impact of different benefit design changes on costs and patient outcomes, providing data-driven recommendations for program adjustments.
Stay updated with healthcare regulations and ensure that pharmacy benefit programs comply with relevant laws and regulations, including those related to data privacy and security.
Assist in audits and compliance reporting as necessary, ensuring transparency and adherence to regulatory requirements.
Provide data-driven recommendations for optimizing pharmacy benefit programs, including formulary management, prior authorization criteria, and cost-saving strategies.
Collaborate with cross-functional teams including Pharmacists, Account Managers, and IT professionals to implement recommended changes and enhance program performance.
Implement data validation processes to ensure data integrity and accuracy, troubleshooting data-related issues and discrepancies promptly.
Communicate complex data analyses clearly and understandably, tailoring messages to diverse audiences, including technical and non-technical stakeholders.
Develop and disseminate best practices for researching and answering our clients' questions about their benefit experiences and efficacies.
Proficiency in data analysis tools such as SQL, Python, or R, and familiarity with data visualization tools like Domo or Power BI, enabling robust and efficient data handling.
Familiarity with PBM software and pharmacy claims processing systems, ensuring seamless integration and analysis of diverse data sources.
Ability to maintain the confidentiality of sensitive medical information and knowledge of HIPAA Privacy and Security Rules
Abide by all obligations under HIPAA related to Protected Health Information (PHI).
If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
Flexibility to understand, appreciate, and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
Qualification
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Required
2 years’ experience in data reporting or analysis role
Strong analytical skills and proficiency in data analysis tools and programming languages, including SQL, Python, or R.
Understanding of pharmacy benefit terminology, formulary management, and medication pricing, providing a solid foundation for effective program analysis.
Previous experience in healthcare analytics, pharmacy benefit management, or a related field, with a preference for experience in healthcare data analysis.
Excellent communication and presentation skills, capable of conveying complex analyses clearly and persuasively.
Attention to detail and the ability to work independently and as part of a team, fostering a collaborative and precise work environment.
Preferred
Familiarity with pharmacy claims coding terminology preferred.
Degree or equivalent experience; preferably in a technology or technical business discipline.
An intermediate level knowledge with any of the following: SQL Server or other RDMS, SSRS, or Power BI.
Company
GalaxE.Solutions
GalaxE.Solutions provides application development, artificial intelligence, and business consulting services.
1,001-5,000 employees
H1B Sponsorship
GalaxE.Solutions 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
2023 (49)
2022 (67)
2021 (66)
2020 (110)
Funding
Current Stage
Late StageTotal Funding
unknown2024-02-29Acquired· by Endava
Leadership Team
Steve Weiss
General Counsel / Chief Financial Officer
Recent News
2024-04-07
Company data provided by crunchbase
