Healthcare Data Analyst assessing US Health Insurance policies for compliance. Utilizing analytics to provide insights and strategies for internal teams.
Responsibilities
Play a critical role in reading, understanding, and assessing the medical and pharmacy policies of US Health Insurance companies
Conduct detailed reviews of medical and pharmacy policies from various US Health Insurance Companies across Commercial, Medicare, and Medicaid plans and formulary validation
Assess these policies in the context of our guidelines & criteria such as payer coverage criteria, formulary status, prior authorization (PA), step therapy (ST), and other utilization management (UM) restrictions
Utilize analytics tools and methodologies to generate insights, providing recommendations for business improvements
Collaborate with internal teams to strategize and optimize business processes & rules based on analytical findings
Clearly communicate findings, implications, and recommendations to internal teams and external partners; ensuring complex information is easily interpretable
Develop and maintain documentation related to policy assessments and compliance activities
Contribute to the internal initiatives, which includes adhoc projects and employee engagement programs
Requirements
Bachelor's degree in Life Sciences (Pharmacology, Dentistry, or related field)
2 to 5 years of experience in Pharma/Healthcare (pharmacovigilance, insurance, health IT)
Certification in SQL, Power BI, or similar technical skills is preferred
Prior experience in the corporate healthcare industry is required
Experience in healthcare policy, insurance, compliance, or related areas with solid knowledge of US healthcare regulations is highly desirable
Familiarity with secondary data sources such as FDA databases, Redbook, and clinical labels is preferred
Strong analytical mindset with keen attention to detail
Proficient in Microsoft 365 and Google Suite Workspace
Technical expertise in Excel required
Working knowledge of SQL and Python or similar programming language is good to have.
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