Job Description

Job Description

Position Summary

The PBM Data Analyst is responsible for collecting, analyzing, and interpreting pharmaceutical data to support decision-making processes within VerusRx. The primary goal is to enhance the efficiency and effectiveness of pharmacy benefit programs while ensuring cost containment and quality patient care.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Gather and compile pharmacy and healthcare-related data from various sources, including claims, prescriptions, and pharmacy networks.
• Ensure data accuracy, completeness, and consistency.
• Apply statistical and analytical techniques to identify trends, patterns, and anomalies in pharmaceutical claim data.
• Perform cost-benefit analysis and cost-effectiveness studies for different medication and treatment options.
• Create and deliver reports, dashboards, and visualizations to convey insights and findings to various team members.
• Develop regular performance reports on key pharmacy benefit metrics.
• Utilize predictive modeling and forecasting techniques to project future pharmacy benefit program costs and utilization patterns.
• Assess the impact of different benefit design changes.
• Stay updated with healthcare regulations and ensure pharmacy benefit programs comply with relevant laws and regulations.
• Assist in audits and compliance reporting as necessary.
• Provide data-driven recommendations for optimizing pharmacy benefit programs, including formulary management, prior authorization criteria, and cost-saving strategies.
• Collaborate with cross-functional teams to implement recommended changes.
• Implement data validation processes to ensure data integrity and accuracy.
• Troubleshoot data-related issues and discrepancies.
• Collaborate with Pharmacists, Account Managers, and other team members to translate data findings into actionable insights.
• Communicate complex data analyses in a clear and understandable manner.
• Proficiency in data analysis tools such as SQL, or data visualization tools like Domo or Power BI.
• Familiarity with PBM software and pharmacy claims processing systems.

Minimum Qualifications (Knowledge, Skills, and Abilities)

• Bachelor's degree in data science, statistics, healthcare management, or a related field.
• Strong analytical skills and proficiency in data analysis tools and programming languages.
• Knowledge of healthcare and pharmacy benefit management principles and regulations.
• Understanding of pharmacy benefit terminology, formulary management, and medication pricing.
• Previous experience in healthcare analytics, pharmacy benefit management, or a related field is typically required, with a preference for experience in healthcare data analysis.
• Excellent communication and presentation skills.
• Attention to detail and the ability to work independently and as part of a team.

** TO ALL RECRUITMENT AGENCIES: Verus Rx, LLC (“VRX”) and its affiliated companies do not accept unsolicited agency resumes. Please do not forward resumes for any of our job postings, to our careers sites, or to any employees of VRX or its affiliates. VRX is not responsible for any fees related to unsolicited resumes.**