Data Analyst - II (MUST HAVE 3+ Years of PBM)
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
Position Summary
We are seeking a detail-oriented and analytical Data Analyst with experience in the Pharmacy Benefit Management (PBM) industry, specifically in managing and analyzing accumulator programs. The ideal candidate will support the design, monitoring, and optimization of accumulator strategies, ensuring accurate tracking of member cost-sharing and benefit utilization.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential function satisfactorily.
• Analyze and interpret data related to accumulator and maximizer programs, including member out-of-pocket costs, copay assistance, and benefit utilization.
• Collaborate with cross-functional teams (clinical, IT, operations) to ensure accumulator logic is correctly implemented and maintained.
• Develop dashboards and reports to track accumulator performance, trends, and anomalies.
• Identify data quality issues and collaborate with stakeholders to resolve discrepancies in accumulator tracking.
• Support audits and compliance reviews related to accumulator program integrity.
• Provide insights and recommendations to improve member experience and plan performance.
• Assist in the integration of accumulator data with claims, eligibility, and formulary systems.
• Monitor and validate accumulator resets, carryovers, and member-level accumulations across benefit years.
• Partner with pharmacy operations and client services to troubleshoot accumulator-related issues and escalations.
• Conduct impact analyses for new accumulator program designs or regulatory changes.
• Collaborate with actuarial and finance teams to assess the financial impact of accumulator strategies.
• Document accumulator logic, data flows, and business rules for internal and external stakeholders.
• Participate in UAT (User Acceptance Testing) for accumulator-related system enhancements.
• Support client reporting needs and ad hoc data requests related to accumulators and member benefits.
Minimum Required Qualifications and Skills
• Bachelor’s degree in data science, Statistics, Health Informatics, or related field.
• 3+ years of experience in the PBM, health insurance, or healthcare analytics industry.
• Strong understanding of accumulator and maximizer programs and their impact on benefit design and member cost-sharing.
• Proficiency in SQL, Excel, and data visualization tools (e.g., Power BI, Tableau).
• Experience working with pharmacy claims data, eligibility files, and benefit structures.
• Excellent analytical, problem-solving, and communication skills.
Preferred Qualifications and Skills
• Experience with Dynamics 365, or other healthcare CRM platforms.
• Familiarity with regulatory requirements related to accumulator programs (e.g., CMS, state mandates).
• Knowledge of rebate and copay assistance program structures.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance; stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision and ability to adjust focus.
Job Type: Full-time
Pay: From $115,000.00 per year
Benefits:
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid holidays
• Paid time off
• Vision insurance
Schedule:
• 8 hour shift
Education:
• Bachelor's (Required)
Experience:
• Pharmacy Benefit Management: 3 years (Required)
• SQL: 3 years (Required)
Work Location: Remote Apply tot his job
We are seeking a detail-oriented and analytical Data Analyst with experience in the Pharmacy Benefit Management (PBM) industry, specifically in managing and analyzing accumulator programs. The ideal candidate will support the design, monitoring, and optimization of accumulator strategies, ensuring accurate tracking of member cost-sharing and benefit utilization.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential function satisfactorily.
• Analyze and interpret data related to accumulator and maximizer programs, including member out-of-pocket costs, copay assistance, and benefit utilization.
• Collaborate with cross-functional teams (clinical, IT, operations) to ensure accumulator logic is correctly implemented and maintained.
• Develop dashboards and reports to track accumulator performance, trends, and anomalies.
• Identify data quality issues and collaborate with stakeholders to resolve discrepancies in accumulator tracking.
• Support audits and compliance reviews related to accumulator program integrity.
• Provide insights and recommendations to improve member experience and plan performance.
• Assist in the integration of accumulator data with claims, eligibility, and formulary systems.
• Monitor and validate accumulator resets, carryovers, and member-level accumulations across benefit years.
• Partner with pharmacy operations and client services to troubleshoot accumulator-related issues and escalations.
• Conduct impact analyses for new accumulator program designs or regulatory changes.
• Collaborate with actuarial and finance teams to assess the financial impact of accumulator strategies.
• Document accumulator logic, data flows, and business rules for internal and external stakeholders.
• Participate in UAT (User Acceptance Testing) for accumulator-related system enhancements.
• Support client reporting needs and ad hoc data requests related to accumulators and member benefits.
Minimum Required Qualifications and Skills
• Bachelor’s degree in data science, Statistics, Health Informatics, or related field.
• 3+ years of experience in the PBM, health insurance, or healthcare analytics industry.
• Strong understanding of accumulator and maximizer programs and their impact on benefit design and member cost-sharing.
• Proficiency in SQL, Excel, and data visualization tools (e.g., Power BI, Tableau).
• Experience working with pharmacy claims data, eligibility files, and benefit structures.
• Excellent analytical, problem-solving, and communication skills.
Preferred Qualifications and Skills
• Experience with Dynamics 365, or other healthcare CRM platforms.
• Familiarity with regulatory requirements related to accumulator programs (e.g., CMS, state mandates).
• Knowledge of rebate and copay assistance program structures.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance; stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision and ability to adjust focus.
Job Type: Full-time
Pay: From $115,000.00 per year
Benefits:
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid holidays
• Paid time off
• Vision insurance
Schedule:
• 8 hour shift
Education:
• Bachelor's (Required)
Experience:
• Pharmacy Benefit Management: 3 years (Required)
• SQL: 3 years (Required)
Work Location: Remote Apply tot his job