Resp & Qualifications

PURPOSE:

The Pharmacy Analyst Functional II supports pharmacy financial performance and contract compliance through analytics, monitoring, reconciliation, and validation of financial guarantees, invoices, and payments. This role ensures accurate documentation, supports audit and compliance activities. The analyst partners with Finance, Account Management, analytics teams and other key stakeholders to deliver accurate reporting, resolve issues and identify insights that improve pharmacy financial performance.

ESSENTIAL FUNCTIONS:

• Partner with cross-functional teams to support audit activities and issue resolution while ensuring accuracy and compliance with organizational standards.
• Analyze pharmacy financial, contract, and operational data to identify trends, variances, risks, and improvement opportunities.
• Monitor, reconcile, and validate financial guarantees and performance measures for Plan-to-PBM and client arrangements.
• Support calculation, validation, reconciliation, and documentation of pharmacy-related payments, including rebates, network discounts, medical rebates, and other guarantee components.
• Validate invoices and payment activity in coordination with Finance and cross-functional partners to ensure accuracy, timeliness, and compliance.
• Prepare reporting, analysis, and documentation for audits, compliance reviews, root cause analysis, and stakeholder requests.
• Partner with analytics teams to develop insights and recommendations that improve visibility into pharmacy financial performance and contract outcomes.
• Support Account Management, Pharmacy leadership and other stakeholder with reporting, analysis, issue resolution and ad-hoc requests.

QUALIFICATIONS:

Education Level: Bachelor''s Degree in Business Administration or related field OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience:

• 2 years experience as a Functional Analyst OR
• 4 years experience in (level 2 or above) operational role.

Preferred Qualifications:

• 7+ years experience in an analytical role preferred. Experience in pharmacy within one or more of the following areas: PBM, health care financials, medical rebates, Medicare, Medicaid and/or Commercial pharmacy operations.

Knowledge, Skills and Abilities (KSAs)

• Highly proficient in Microsoft Office and similar applications.
• Ability to create graphics and report to non-technical audiences.
• Self-starter and ability to collaborate in a team environment.
• Excellent communication skills both written and verbal.
• Ability to synthesize large complex data and analysis into actionable insights.
• Apply strong critical thinking and problem-solving skills to analyze issues, data and identify solutions.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $55,296 - $109,824

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate''s work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case''s facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-LJ1

Remote

Skills:
Analysis Skills, Billing, Business Administration, Channel Strategies, Communication Skills, Contract Analysis, Corporate Policies, Cross-Functional, Customer Support/Service, Data Analysis, Documentation, Equal Employment Opportunity (EEO), Finance, Financial Analysis, Financial Management, Functional Analysis, Genetics, Graphics, Healthcare, Identify Issues, Leadership, Maintain Compliance, Medicaid, Medicare, Microsoft Office, Performance Metrics, Pharmacy, Physical Demands, Presentation/Verbal Skills, Problem Solving Skills, Reconciliation, Regulatory Compliance, Reporting Skills, Root Cause Analysis, Sales Management, Support Documentation, Team Player, Time Management, Trend Analysis, Writing Skills

Blue Cross and Blue Shield Association

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Company Size:
2,000 to 2,499 employees

Industry:
Insurance

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