Blue Cross and Blue Shield Association logo

Medical Informatics Analyst, Consultant - Pharmacy

Blue Cross and Blue Shield Association
  • Oakland, CA
    1 day ago

    Job Description

    Your Role

    The Pharmacy Financial Analytics team. The Medical Informatics Consultant will report to the Sr. Principal Medical Informatics Analyst of Pharmacy Financial Analytics. In this role, you will play a key part in advancing our organization''s analytical capabilities by supporting network and rebate reporting, reconciliation processes, model development, and automation initiatives. Your work will directly empower leadership with the tools, insights, and data needed to make informed strategic decisions, drive operational excellence, and support the continued growth and success of the organization through innovative, data-driven solutions.

    Your Knowledge and Experience

    • Requires a bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
    • Requires 7 years of relevant experience delivering analytics (cost, quality, utilization, and/or outcomes) with enterprise impact
    • Requires 5 years of prior pharmacy experience
    • Requires SAS Certified Advanced Programmer credential (or equivalent) or advanced analytics certification (e.g., R, Python)

    Hybrid

    This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

    Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

    Your Work

    In this role, you will:

    • Develop, optimize, and maintain complex SQL queries to extract, transform, and analyze pharmacy, claims, financial, and operational data.
    • Use SAS and other analytical tools to manipulate large healthcare datasets, support statistical analysis, and contribute to predictive model development.
    • Support the design, maintenance, and enhancement of underwriting tools used to evaluate pharmacy cost, utilization, revenue, and performance trends.
    • Design, automate, and maintain financial reporting to monitor pharmacy revenue streams, dispensing margins, rebate activity, billing accuracy, and key performance indicators.
    • Perform financial reconciliations across pharmacy claims, rebate, inventory, operational, and general ledger data to ensure accuracy, identify variances, and support issue resolution.
    • Analyze financial and operational trends to identify cost-saving opportunities, revenue impacts, process gaps, and business performance drivers.
    • Translate complex pharmacy and financial data into clear insights, recommendations, and presentations for business leaders and cross-functional partners.
    • Partner with Pharmacy, Finance, Underwriting, Actuarial, and operational teams to support strategic initiatives, improve reporting capabilities, and drive data-informed decision-making.

    Your Work

    In this role, you will:

    • Develop, optimize, and maintain complex SQL queries to extract, transform, and analyze pharmacy, claims, financial, and operational data.
    • Use SAS and other analytical tools to manipulate large healthcare datasets, support statistical analysis, and contribute to predictive model development.
    • Support the design, maintenance, and enhancement of underwriting tools used to evaluate pharmacy cost, utilization, revenue, and performance trends.
    • Design, automate, and maintain financial reporting to monitor pharmacy revenue streams, dispensing margins, rebate activity, billing accuracy, and key performance indicators.
    • Perform financial reconciliations across pharmacy claims, rebate, inventory, operational, and general ledger data to ensure accuracy, identify variances, and support issue resolution.
    • Analyze financial and operational trends to identify cost-saving opportunities, revenue impacts, process gaps, and business performance drivers.
    • Translate complex pharmacy and financial data into clear insights, recommendations, and presentations for business leaders and cross-functional partners.
    • Partner with Pharmacy, Finance, Underwriting, Actuarial, and operational teams to support strategic initiatives, improve reporting capabilities, and drive data-informed decision-making.

    Numbers & Facts

    LocationOakland, CA
    IndustryInsurance
    Company Size2,000 to 2,499 employees
    Websitehttps://www.bcbs.com/about-us/careers

    About Company

    At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

    Skills

    • Actuarial Skillsunmatched
    • Analysis Skillsunmatched
    • Automationunmatched
    • Billingunmatched
    • Consultingunmatched
    • Cost Controlunmatched
    • Cross-Functionalunmatched
    • Financeunmatched
    • Financial Analysisunmatched
    • Financial Operationsunmatched
    • Financial Trend Analysisunmatched
    • General Ledger Accountingunmatched
    • Health Informaticsunmatched
    • Healthcareunmatched
    • High School Diplomaunmatched
    • Leadershipunmatched
    • Network Supportunmatched
    • Operational Auditunmatched
    • Operational Supportunmatched
    • Performance Metricsunmatched
    • Pharmacyunmatched
    • Predictive Modelingunmatched
    • Problem Solving Skillsunmatched
    • Process Modelingunmatched
    • Reconciliationunmatched
    • Reporting Skillsunmatched
    • SQL (Structured Query Language)unmatched
    • Statistical Analysis System (SAS)unmatched
    • Statisticsunmatched
    • Strategic Planningunmatched
    • Training Data Setsunmatched
    • Trend Analysisunmatched
    • Underwritingunmatched

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