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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:

·       General direction and supervision by Manager of Pharmacy Contracting and Reporting

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 ana