Health Informatics Sr Analyst

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Job Description

The Health Informatics Analyst Sr leads advanced data initiatives that support clinical programs, cost containment strategies, and operational effectiveness. This role partners with cross-functional teams, including clinical services, pharmacy operations, product management, and client services, to transform complex healthcare data into actionable insights. The position applies advanced statistical, analytic, and business acumen, and champions evidence-based decision-making, regulatory compliance, and improved patient and business outcomes.

Responsibilities

• Analyze large-scale healthcare claims, eligibility, provider, and clinical data to identify trends, address business needs, and inform organizational strategies
• Design, develop, and deliver advanced regular and ad-hoc reports for pricing, risk evaluation, medication adherence, formulary compliance, and utilization management
• Partner with stakeholders and lead the development of forecasting models, predictive indicators, and statistical analyses to measure program compliance and improve outcomes
• Lead the design, validation, and automation of dashboards and visualizations, ensuring scalability and regulatory alignment
• Provide data-driven recommendations for formulary design, prior authorization criteria and drug utilization review (DUR) programs
• Serve as a key partner to leadership in defining issues, selecting analytic methodologies, and interpreting complex data for executive decision-making
• Mentor and guide Analysts, providing technical leadership and ensuring alignment with best practices and evolving industry standards
• Other duties as assigned

Minimum Qualifications

• Bachelors degree in Health Informatics, Public Health, Computer Science, Data Science, Statistics or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required

• 5 years of work experience in healthcare data analytics, with at least 3 years in the PBM or managed care environment

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Knowledge of and ability to analyze data in Tableau, Qlik, Power BI, or similar platforms
• Advanced knowledge of pharmacy claims data, drug classifications, formulary management and rebate processes
• Ability to work under tight deadlines in a highly dynamic environment
• Strong knowledge of pharmacy benefit structures, drug pricing and claims processing
• Demonstrated competency and ability in developing efficient and effective solutions to complex business problems
• Familiarity with drug coding systems (NDC) and medical coding (ICD, CPT, HCPCS)

Preferred Qualifications

• Experience with healthcare medical and pharmacy claims data manipulation and analysis
• Experience with of transact-SQL (MS SQL or Oracle)
• Experience with SQL, GCP, Python, or SAS for data extraction and analysis
• Experience with clinical decision support systems
• Certifications such as Certified Health Data Analyst (CHDA) or PMP are a plus
• Master's degree in Health Informatics, Public Health, Computer Science, Data Science, Statistics or a related field

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.