PBM Data Analyst

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a PBM Data Analyst at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Data analyst needed to support Ohio and Texas PBM accounts. Perform ad hoc requests via SQL databases on a need basis. Experience using SQL, data models, data element dictionary and schema to perform data, system and business analysis/reporting. Here are the details on this position.

Your role in our mission

• PBM Practice Business Analyst supporting various accounts
• Data analyst/data scientist preferred
• Support PBM implementations, maintenance and configuration
• Configure new and revised claims adjudication logic within a pharmacy claims system
• Configuration validation, configuration peer review.
• Perform ad hoc requests via SQL databases on a need basis
• configuring and loading rule sheets into various PA systems
• Troubleshooting and fixing system configuration errors, performing investigations and root cause analysis of submitted tickets, and ensuring day to day issues are identified and appropriately addressed
• Collaborate with various teams to ensure testing efforts align with system deliveries and business processes
• Preparing PBM Statistics and Reporting

.... your role continued

• Attend / Participate in the Gainwell Technologies (GWT) National Pharmacy Team Meeting
• Generate reports/track reporting
• Identify product improvements and submit Change Requests
• Troubleshoot complex claims issues 
• Subject matter expert on projects that directly impact the PBM practice
• Collaborate with product engineers on new product enhancements 
• Designing and developing test plans and coordinate user acceptance testing 
• Collaborate with product engineers to troubleshoot system issues

• Conduct data drill down to identify best strategic practices 

What we're looking for

• Experience using SQL, data models, data element dictionary and schema to perform data and business analysis. Previous PBM experience and/or experience working in Medicaid or Medicare environments
• Must be knowledgeable of pharmacy claims data, formats and restrictions including but not limited to NCPDP codes
• Analytical and data analysis skills within a technical environment preferably SQL
• Experience in performing pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters
• Experience identifying patterns within quantitative data, drawing conclusions, and recommending solutions and approaches, skilled with end-to-end issue resolution
• Knowledge of computer programming concepts such as rule-based configuration, development
• Advanced knowledge in Microsoft Excel and other software for conducting quantitative analysis 
• Strong analytical and business policy administration skills, as well as quality testing experience
• Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel
• Utilize your ability to manage multiple assignments while maintaining quality standards and meeting assigned deadlines

What you should expect in this role

• Candidate is required to reside within commuting distance to Richmond, CA. 
• This will be primarily a remote position but will be required to report to office as needed by client.
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• The deadline to submit applications for this posting is February 4, 2025.

#LI-HC1

#LI-SQL Query

#LI-PBM Data Analyst

The pay range for this position is $51,900.00 - $74,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.