Pbm Operations Analyst Jobs (NOW HIRING)

Location: Las Vegas, NV

Category: Finance

Type: Full-time

Min. Experience: Manager

Company Bio:

Founded by industry pioneers, our client provides simple and affordable pharmacy benefit programs to employer groups, unions, public sector groups, health systems, and other payers throughout the United States. As the industry's only PBX, this company is creating real value for plan sponsors on day one through purchasing scale and continued management via innovation and transparency. Our model is designed to improve an out-of-touch healthcare model to make pharmacy benefits simple and affordable for plan sponsors and members.

Job Overview:

As the Manager of Underwriting, you will play a pivotal role in supporting the RFP processes and conducting financial analyses for company and its clients, and the team responsible for execution. Your responsibilities will include conducting repricing exercises, analyzing value propositions, identifying trend drivers, and monitoring contract compliance. Collaborating closely with cross-functional teams, you will drive the success of our organization, enhance member health outcomes, and contribute to the growth of our organization.

Responsibilities:

As Manager, Underwriting your key responsibilities will include:

• Support RFP processes by assisting in the completion of financial questionnaires.

• Analyze the value proposition for prospective clients.

• Manage repricing activities and related requests

• Manage repricing exercises and retrospective analyses of deal performance for clients and their advisors.

• Conduct in-depth financial analysis to compare relative value between different deal structures.

• Oversee the evaluation of client ROI or opportunities arising from programs.

• Provide expert responses to complex questions from internal resources, including implementation and account teams.

• Collaborate with the clinical team to develop therapeutic class or category-based financial scorecards for future strategic planning.

• Address other financial inquiries originating from company's administration and analytics teams.

• Provide oversight and training to team members who have been delegated underwriting projects.

• Performs miscellaneous job-related duties as assigned.

Qualifications:

To excel in this role, you should possess the following qualifications:

• Proficient in collecting and extracting relevant data from various sources, including pharmacy insurance claims databases. Skilled in utilizing data analysis tools and techniques to identify trends, patterns, and insights that contribute to informed decision-making.

• Ability to assess and quantify risk factors associated with PBM contracts and pricing strategies. Proficiency in identifying potential financial risks and proposing mitigation strategies.

• Strong aptitude for building complex financial models to simulate different scenarios, pricing structures, and underwriting outcomes. Expertise in using modeling software and spreadsheet applications for accurate financial projections.

• In-depth understanding of the intricate details and terminology commonly found in PBM contracts. Proficient in reviewing, interpreting, and negotiating contract terms to optimize financial outcomes and minimize potential liabilities.

• Familiarity with statistical methods and techniques for evaluating data significance and drawing meaningful conclusions. Capable of performing statistical analyses to support underwriting decisions and pricing strategies.

• Excellent verbal and written communication skills with the ability to convey complex financial concepts and analysis results in a clear and understandable manner. Comfortable presenting findings to internal teams, clients, or stakeholders.

• Keen attention to detail when working with financial data, contracts, and documentation. Ensures accuracy and precision in all aspects of underwriting and financial analysis.

• Strong problem-solving abilities, capable of identifying issues, analyzing root causes, and proposing effective solutions. Adaptable in addressing challenges and making data-driven recommendations.

• Awareness of regulatory requirements and industry standards related to PBM operations and healthcare finance. Ensures that underwriting practices align with applicable laws and regulations.

• Effective teamwork and collaboration skills to work closely with cross-functional teams, including clinical, implementation, and account teams. Capable of integrating financial insights into broader strategic initiatives.

• A commitment to staying updated with industry trends, emerging technologies, and best practices in PBM underwriting and financial analysis. Willingness to pursue relevant certifications or professional development opportunities.

• 4+ years of previous experience in pharmacy benefit management/administration, with a specific functional background in data analytics and claims data.

• Knowledge of reporting, data analytics, and problem solving using analytical tools such as Excel, SAS, SQL, Power BI, and/or other ad hoc Query Tools.

Education:

Bachelor's degree in finance, statistics, mathematics, economics, or equivalent work experience; master's degree a plus.

License Requirement:

None

Job Benefits:

Health, Dental, Vision, Life, 401k, Paid Time Off.

Location:

Remote with limited travel to client locations, internal business meetings, and other locations as needed.