Sr. Pharmacy Data Analyst Manager

UNITE HERE HEALTH • Aurora, IL

113d • $124,900 - $156,200

About The Position

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! The Senior Pharmacy Data Analyst Manager leads the analysis and interpretation of pharmacy benefit management (PBM) data to support clinical, operational, and financial initiatives, enabling data-driven decision-making and strategic planning across the PBM. This role oversees pharmacy data governance, ensures data quality and integrity and supports the development and delivery of reporting and analytics solutions.

Requirements

• 7~10 years or more years’ experience in data analytics, with a specific focus on PBM pharmacy data.
• 4+ years of experience working at a PBM.
• Strong understanding of PBM operations, including benefit plan design, formulary management, claims adjudication, and eligibility processing.
• Experience working with data warehouses, large datasets, and structured/unstructured data sources.
• Strong understanding of PBM pharmacy claims data and healthcare analytics.
• Working knowledge of industry coding (revenue codes, ICD 9 or 10’s, HCPCS, CPT codes, Medispan, etc.).
• Working knowledge of Formulary and Drug management concepts (Tiers, Prior Authorization, Quantity Limits, Step Therapy, etc.).
• Ability to format reports and explain results.
• Demonstrated ability to manage complex projects.
• Organizational and time management skills to prioritize workload and meet deadlines required.
• Must be results oriented with the ability to change priorities as needed.
• Excellent verbal and written communication, client-facing, and organizational skills.
• Familiarity with claims processing systems (e.g., RxCLAIM) and Medispan or First Databank).
• Proficiency with project management tools (e.g., MS Project, Jira, Smartsheet) and Microsoft Office Suite.

Nice To Haves

• Knowledge of SAS, R, or Python for advanced data manipulation or statistical modeling.
• Experience with formulary coding options and pharmacy network configuration and claims adjudication.
• Knowledge of clinical drug information or manufacturer rebates preferred.

Responsibilities

• Gather and compile pharmacy data from various sources (claims, prescriptions, networks) and analyze it to identify trends, patterns, and anomalies.
• Develop, build, and maintain reports, dashboards, and visualizations to track key performance indicators (KPIs) for leadership and management.
• Perform cost-benefit analysis and cost-effectiveness studies for various medications and treatment options, assessing the impact of benefit design changes.
• Assist with input of formulary and drug management requirements to data warehouse; oversight of formulary and drug management tables.
• Ensure that pharmacy benefit programs comply with relevant healthcare regulations and assist with compliance reporting and audits.
• Provide data-driven recommendations for optimizing pharmacy benefit programs, including formulary management, prior authorization criteria, and cost-saving strategies.
• Partner with cross-functional teams to interpret data findings and implement recommended changes.
• Ensure the accuracy, integrity, and completeness of PBM data by implementing and monitoring data validation processes.
• Conduct ad-hoc data analysis and support special projects as needed to address evolving business needs.
• Communicate findings of data investigations and manage expectations for internal and external stakeholders.
• Maintains a thorough understanding of the data warehouse process, PBM contract requirements, reconciliations, vendor agreements, reporting applications and reporting requirements.
• Helps execute strategic vision for data warehouse enhancements/improvements to serve Analytics needs.
• Reviews and corresponds to vendor requests and inquiries for data transfer activities.
• Maintains a high level of professionalism and sense of urgency to ensure PBM expectations are consistently met.
• Reviews and completes financial sections of RFP/RFIs, market checks, and contract renewals and forecasts accurate cost assumptions into pricing offers.
• Sets goals and achieve measurable results.
• Contributes ideas to plans and achieving department goals.
• Exemplifies the Fund’s BETTER Values and professional effectiveness dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion.
• Performs other duties as assigned within the scope of responsibilities and requirements of the job.

Benefits

• Medical
• Dental
• Vision
• Paid Time-Off (PTO)
• Paid Holidays
• 401(k)
• Short- & Long-term Disability
• Pension
• Life
• AD&D
• Flexible Spending Accounts (healthcare & dependent care)
• Commuter Transit
• Tuition Assistance
• Employee Assistance Program (EAP)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 251-500 employees