It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Senior Pharmacy Data Analyst is a highly experienced and results-driven professional who plays a critical role in advancing the strategic objectives of the Pharmacy Department. Reporting to the Manager of Pharmacy Contracting and Reporting, this role operates with a high degree of autonomy and precision, leveraging deep expertise in pharmacy data analytics to deliver timely, actionable insights that drive operational excellence, regulatory compliance, and member health outcomes.
This individual is a master of data strategy—skilled in SAS, SQL, and advanced Microsoft tools—with a proven ability to architect complex data models, streamline reporting processes, and lead cross-functional initiatives. The Senior Analyst is responsible for developing and maintaining enterprise-level dashboards, overseeing regulatory submissions, and serving as the Pharmacy Data Steward, ensuring data integrity across systems and stakeholders.
With a minimum of 10 years of industry experience, the ideal candidate demonstrates exceptional analytical acumen, strategic foresight, and a commitment to producing high-quality deliverables efficiently and independently. This role demands a proactive leader who can translate complex data into compelling narratives, influence decision-making, and support cost-effective, data-driven pharmacy benefit management.
Our Investment in You:
- Full-time remote work
- Competitive salaries
- Excellent benefits
Key Functions/Responsibilities:
- Develop and maintain a centralized dashboard for tracking pharmacy financial, operational, and clinical performance measures.
- Lead the process of regulatory reporting from development, validation, and submission collaborating with vendor partners to ensure data accuracy.
- Conduct data queries to monitor performance metrics, including Medicare STAR measures and quality improvement initiatives.
- Oversee PBM submission of all Part D claims to CMS as PDEs, identifying discrepancies and resolving errors to ensure 100% alignment.
- Assume the leadership role of Pharmacy Data Steward, advising cross-functional departments on data exchange specifications and serving as the subject matter expert for pharmacy data integrity.
- Support program processes by conducting User Acceptance Testing (UAT) and Quality Assurance (QA) testing.
- Collaborate with Pharmacy Department team members to identify, prioritize, and analyze customer needs and requests to include the development and execution of sophisticated data-driven strategies that are closely aligned with the company's overarching mission and strategic objectives
- Communicate effectively with internal cross-functional areas regarding pharmacy programs, formulary management, and pharmacy processes.
- Document workflows, perform analysis, and contribute to the design of systems to meet Pharmacy data needs.
- Deliver compelling presentations of findings and insights to internal stakeholders, effectively communicating complex concepts in a clear, concise, and persuasive manner using Utilize leading BI tools such as Tableau or Power BI.
- Architect and implement intricate data models, data flows, and data integration processes to ensure the accuracy, reliability, and efficiency of data collection, storage, and retrieval mechanisms.
- Engage collaboratively with cross-functional teams, including business stakeholders, data scientists, and developers, to identify optimization opportunities and develop innovative, data-driven solutions.
- Utilize leading BI tools such as Tableau or Power BI to create dynamic, visually compelling reports and distribute actionable insights effectively.
- Harness advanced tools such as Excel (including VBA), Python, or R to manipulate, analyze, and visualize data with precision and sophistication.
- Other duties as assigned
Supervision Received:
Qualifications:
Education Required:
- Bachelor's degree in mathematics, information management, information systems, statistics, or an equivalent combination of education, training, and experience.
Education Preferred:
- Master's degree preferred.
Experience Required:
- Minimum of 5 years of healthcare experience.
- Working knowledge of industry coding standards (e.g., generic product indicators, national drug codes, GPI’s, etc.).
Experience Preferred/Desirable:
- Minimum of 10 years in health insurance or with a PBM
- Working knowledge of industry coding standards (e.g., generic product indicators, national drug codes, GPI’s, etc.).
- Extensive experience analyzing pharmacy claims data, formulary utilization, and drug cost trends.
- Familiarity with Medicare Part D data, STAR measures, and PDE submissions
- Required Licensure, Certification or Conditions of Employment:
- Successful completion of pre-employment background check
Competencies, Skills, and Attributes:
- Excellent written and verbal communication skills, adept at presenting complex data insights to senior leadership, cross-functional teams, and external partners.
- Advanced technical proficiency in Microsoft Excel (pivot tables, advanced formulas, Power Query), with strong proficiency in SQL for data extraction, transformation, and analysis. Skilled in additional BI and reporting tools (Tableau, Power BI, or equivalent).
- Deep understanding of IT and business processes, with proven ability to translate clinical and operational requirements into actionable technical solutions.
- Demonstrated ability to influence, consult, and build consensus across multiple stakeholders, driving collaboration between business, IT, and vendor teams.
- Strong clinical and operational problem-solving skills with experience in synthesizing large, complex datasets into actionable insights and executive-ready reports.
- Proficient in designing, developing, and automating queries, dashboards, and ad hoc reports that support strategic decision-making.
- Committed to data integrity, accuracy, and quality, with meticulous attention to detail and validation processes.
- Quick to adopt new systems, tools, and analytic approaches, consistently staying ahead of industry trends and best practices.
- Ability to organize, synthesize, and analyze large volumes of information.
- Skilled at prioritizing multiple initiatives, managing timelines, and delivering high-quality outputs in fast-paced environments.
- Detail-oriented with a commitment to producing analytic products of the highest accuracy.
- Strong interpersonal skills with a track record of thriving in collaborative, team-based environments.
Working Conditions and Physical Effort:
- Ability to work OT during peak periods.
- Regular and reliable attendance is an essential function of the position.
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.
Compensation Range
$77,000 - $111,500
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.
Note: This range is based on Boston-area data, and is subject to modification based on geographic location.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
Bachelor's degree in mathematics, information management, information systems, statistics or equivalent; 5+ years healthcare experience; knowledge of industry coding standards; advanced Excel, SQL, BI tools; background check required.
Key Responsibilities
- developing dashboards
- leading regulatory reporting
- conducting data queries
Skills & Tools
SAS, SQL, Microsoft Excel, Power Query, Tableau, Power BI, Python, R, VBA
Job Details
- Category: Data and Analytics
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — United States
- Salary: USD 77,000 – 111,500 / year
- Languages: English
Benefits
- 401k matching
- Generous paid time off
- Retirement plan
About WellSense Health Plan
A nonprofit health insurance company serving members across Massachusetts and New Hampshire. — Industry: Healthcare