Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. Coordinate projects for senior management. Bachelor's Degree in Business Administration, Health Care, or a related field is preferred. Two (2) or more years of experience in related field required. RESPONSIBILITIES/TASKS: • Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues. • Possesses and maintains a comprehensive understanding and knowledge of Healthcare business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies. • Assists in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters. • Communicates results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions. • Recommends and implements solutions to identified problems/root cause of issues. • Provides expertise and guidance to unit and corporate staff as required. • Represents and participates in group or committee discussions. • Supports PBM audit and analytics to support Medicare pharmacy services business team. • Builds and supports business reports to be included in executive dashboard. • Assist with all functions related to Pharmacy Benefit Manager (PBM) oversight for Medicare Advantage Part D plans. • Receive and respond to plan related member and provider inquires. • Troubleshoot problems, inquiries, and provide timely response. • Works with internal and external partners to ensure compliance with CMS regulations. • Performs routine tracking, auditing, and reporting of performance in relation to CMS requirements. • Supports the organization in the event of an internal or external audit. • Coordinate review of Part D member and provider communications. • Recommends and assists with development of policies and procedures and desk level guides. • Assists personnel (both internal and external) by answering questions, supplying information, and maintaining metric and performance dashboards. • Assist in Monitoring reports to track operational effectiveness and vendor service levels. • Report reconciliation in multiple software environments. • Maintain drug lists and HCPCs changes or updates for Part B Utilization Management. This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. Top 3 Required Skills/Experience – The most important must-have skills. • Health plan, PBM or related experience – at least 2 years • Strong computer skills and use of existing software packages (Excel, Power Point, Word, Outlook, etc.) • Knowledge of claims processing and prescription drug names Required Skills • Working knowledge of Medicare Part B and Part D • Ability to plan, organize, direct, and control projects. • Ability to lead and contribute to process improvement projects. • Strong communication skills with the ability to understand, interpret, and communicate ideas. • Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc). • Strong analytical, organizational, planning, and problem-solving skills. • Ability to effectively interface with employees at all levels. • Ability to understand and apply statistical inference. Preferred Skills • CMS Part D knowledge & CMS regulations • Knowledge of PBM systems and tools • Health plan experience Education • Bachelor's degree preferred **Category** _Analyst_ **Function** _Information Technology_ **Req ID** _JN -102024-121666_