Plan Design Analyst

What You Will Do:

• 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.

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 pharmacy benefit management.
• 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.

Desired

• 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.

Education

• Bachelor's degree in data science, statistics, healthcare management, or a related field; advanced degree preferred.

GalaxE, now Endava, is a professional IT services firm that specializes in platform-driven solutions and the use of automation to achieve enterprise business transformation and mission-critical change for some of the largest companies in the world. Using our proprietary solution set, GxFource®, we apply machine learning techniques and predictive analytics tools as part of a broad artificial intelligence strategy that provides effective impact and data-driven business transformation. 

Since its founding, GalaxE has been dedicated to advancing the benefits of technology. Recently, we have joined forces with Endava, to offer our employees global exposure and enhanced opportunities. As we continue that legacy and look to the future, a focus on business enablement through agile, cost-efficient, and effective integration of people, process, and technology anchors our success. We revolutionize change in the costs of doing business that transform companies and their ability to leap beyond the competition.

We value people and are committed to diversity and inclusion where our employees are made to feel comfortable and are encouraged to be authentic.

We are always looking for passionate, entrepreneurial-minded innovators and disrupters; game-changers that take ownership of the work they produce and bring it each and every day. Working with like-minded team members you will get a chance to discover, develop, and use cutting-edge technologies to transform the way we deliver creative business solutions.

Sound like you? Join us and find out for yourself what it means for you, and your career, to be part of the GalaxE team. Let’s build something, together.

*Equal Opportunity Employer/Veterans/Disabled

** Pay is based on several factors including market location and may vary depending on actual job-related knowledge, skills, and experience.

Physical Requirements:

• Prolonged periods of remaining stationary at a desk and working on a computer
• Must be able to lift to 15 lbs., as needed
• Must be able to work on-site (corporate/client offices), as needed (not applicable for 100% remote roles)
• Occasionally required to bend, kneel, crouch, and reach overhead.
• Hand-eye coordination necessary to operate computers and various pieces of office equipment. 
• Specific vision abilities required include close vision, the ability to tolerate fluorescent lighting, and the ability to adjust focus.

Employees must be able to perform the physical requirements of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees requiring accommodations to perform the essential functions of their jobs, absent undue hardship.

For more information, please visit https://info.endava.com/galaxe-has-joined-endava