[Hiring] Health Informatics Sr Analyst @Prime Therapeutics

Role 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.

• 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.

Qualifications

• Bachelor's 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.

Requirements

• 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 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.

Benefits

Potential pay for this position ranges from $94,000.00 - $160,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.