Your Role

The Cost of Healthcare Trendsetters & Pharmacy Support team analyzes and provides emerging healthcare cost trend drivers. The Medical Informatics Analyst IV will report to the Actuarial Manager.

Your Work

In this role, you will:

• Conduct independent analysis of high complexity under minimal supervision and guidance
• Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
• Produce analysis of high complexity under the guidance and direction of the Actuarial Manager
• Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of analysts at lower levels and may involve collaboration with more than one team
• Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower level analysts and analysts in other Departments
• Have overall responsibility and accountability for leading and managing pharmacy support work products related to target setting, reconciliation, and reporting (internal and/or external) for Pharmacy related programs.
• Lead and/or support other general program operations work, ranging from savings projection, accrual setting, addressing data issues and developing solutions, executing program renewals/conversions, iterative model design changes, improving and streamlining operations efficiency
• Direct, coordinate, and/or develop evaluation and financial reporting standards for internal and external reports
• Lead, coordinate and/or develop strategic, market and competitive analysis
• Ensure team follows existing, validates, and/or develops new work-flow procedures or policies

Your Knowledge and Experience

• Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
• Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
• Requires at least 7 years of prior relevant experience
• Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
• Requires health insurance data background including ICD-10 codes, utilization measurement, and service type categorization
• Prior experience related to pharmacy claim data preferable

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.