PBM Data Analyst I

PBM Data Analyst I - REMOTE Role And Responsibilities The PBM Data Analyst I at Liviniti is responsible for transforming pharmacy, healthcare, operational, and client data into trusted insights that improve pharmacy benefit program performance, operational efficiency, cost management, and patient outcomes. This role combines strong business acumen, advanced analytics, modern data platforms, AI-enabled tools, data visualization, and disciplined data governance. The analyst partners with Operations, IT, Clinical, Account Management, Compliance, and leadership teams to build reliable reporting, identify trends and anomalies, support forecasting, and recommend data-driven actions. The following objectives further define the key job functions Data Collection, Integration and Management • Gather, validate, and analyze data from pharmacy claims, eligibility, formulary, clinical programs, prior authorization, customer operations, pharmacy networks, vendor files, APIs, and other PBM-related sources. • Work with structured and semi-structured data across SQL Server, Snowflake, MongoDB or other NoSQL databases, cloud data platforms, flat files, and enterprise reporting environments. • Partner with IT and data engineering teams to understand data pipelines, data models, source-to-target mappings, business rules, lineage, and data quality controls Analytics, Reporting and Business Intelligence • Write, optimize, and validate SQL queries and analytical logic to support recurring reporting, dashboards, ad hoc analysis, operational monitoring, and decision-making. • Build and maintain dashboards, scorecards, self-service reports, and visualizations using tools such as Power BI, Tableau, Excel, or comparable business intelligence platforms. • Analyze trends, patterns, outliers, and performance drivers across time periods, client segments, claim types, operational processes, and benefit plan designs. • Translate business questions into analytical approaches, define KPIs, document metric logic, and present insights in a clear, actionable format for audiences AI-Enabled Analytics, Automation and Forecasting • Use AI-enabled analytics tools, natural-language query capabilities, and automation responsibly to accelerate data profiling, variance analysis, documentation, forecasting, and insight generation. • Apply statistical techniques, forecasting methods, and basic machine learning concepts to support cost, utilization, operational, and clinical program analysis. • Identify opportunities to automate recurring reporting, exception monitoring, data validation, and client-facing analytics while maintaining accuracy, explainability, and governance standards Data Quality, Governance, Compliance and Security • Develop and execute data validation, reconciliation, and output verification processes to ensure accurate, complete, consistent, and fit-for-purpose reporting. • Support data governance by documenting definitions, assumptions, business rules, report logic, data sources, and change impacts. • Protect confidential information and comply with HIPAA, PHI handling requirements, privacy policies, security standards, and internal compliance procedures. • Assist with audits, regulatory reporting, client inquiries, and issue investigations by producing accurate, traceable, and well-documented analysis. Program Optimization and Cross-Functional Collaboration • Provide data-driven recommendations to improve pharmacy benefit programs, formulary strategies, prior authorization processes, claim adjudication, client outcomes, and operational performance. • Collaborate with pharmacists, account managers, operations leaders, product owners, compliance partners, vendors, and technology teams to implement analytic solutions and resolve data-related issues. • Communicate complex findings through concise narratives, dashboards, presentations, and recommendations tailored to leadership, client-facing teams, and operations Additional Responsibilities • Maintain confidentiality of sensitive medical information and knowledge of HIPAA Privacy and Security Rules. • Abide by all obligations under HIPAA related to Protected Health Information (PHI). • Report any suspected HIPAA violation to the Compliance Officer and/or Human Resources. • Attend, complete, and demonstrate competency in all required HIPAA training offered by the company. • Remain flexible as duties, responsibilities, technologies, and priorities evolve with business needs Required Skills And Competencies • Strong written, verbal, and visual communication skills with the ability to explain complex data clearly to business, technical, clinical, and executive audiences. • Advanced SQL skills, including joins, aggregations, common table expressions, window functions, stored procedures, performance tuning, and validation of complex query logic. • Experience with modern data platforms such as Snowflake, SQL Server, Azure Synapse, Databricks, BigQuery, Redshift, or comparable cloud data warehouse/lakehouse technologies. • Working knowledge of NoSQL or document-oriented databases such as MongoDB, including concepts for semi-structured data, JSON, collections, and data extraction. • Proficiency with business intelligence and visualization tools such as Power BI, Tableau, Domo, Looker, or similar platforms. • Strong Excel skills, including pivot tables, advanced formulas, data validation, and ad hoc analysis. • Working knowledge of Python, R, or similar tools for data preparation, statistical analysis, automation, and exploratory analysis. • Understanding of AI-enabled analytics, natural-language query tools, automated insight generation, and responsible use of AI in a healthcare data environment. • Familiarity with data governance, data quality, metadata, lineage, metric definitions, and documentation standards. • Ability to work with large datasets, APIs, SFTP/FTP file exchanges, vendor data feeds, and recurring data pipelines. • Knowledge of PBM, healthcare, pharmacy claims, eligibility, benefit design, formulary, prior authorization, or claims adjudication data preferred. • Demonstrated problem solving, analytical thinking, attention to detail, time management, curiosity, and accountability. Position Type And Expected Hours of Work • Full-time, salary/exempt position. • Some flexibility in hours is allowed, but the employee must be available during the “core” work hours of 8:00 AM to 5:00 PM CT. We cover clients from the West to the East Coast; work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends, and holidays pursuant to industry demands. Travel - This position requires minimal travel What We Have to Offer Our benefits package is designed to keep our employees happy - physically, mentally and financially. • Medical, Dental and Vision Insurance • Disability and Life Insurance • Employee Assistance Program • Remote Work Options • Generous Paid-Time Off • Annual Reviews and Development Plans • Retirement Plan with company match immediately 100% vested Required Education And Experience • Undergraduate degree in Data Analytics, Information Systems, Computer Science, Statistics, Business Analytics, Healthcare Informatics, or a related discipline; equivalent experience may be considered. • 2+ years of experience in data reporting, analytics, business intelligence, healthcare analytics, PBM analytics, or comparable analytical roles. • Hands-on experience developing reports, dashboards, analytical queries, and business insights using SQL and at least one modern BI or analytics platform Preferred Education And Experience • Experience with pharmacy claims, PBM operations, healthcare data, NCPDP-related concepts, or benefit plan terminology preferred. • Experience with Snowflake, MongoDB, Python, Power BI, Tableau, Domo, dbt, cloud data platforms, APIs, or automated data pipelines preferred. • Familiarity with data modeling, dimensional reporting, semantic models, dashboard governance, quality assurance, or analytics product ownership preferred. • Exposure to AI-assisted analytics, machine learning concepts, forecasting, anomaly detection, or natural-language analytics tools preferred Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Liviniti, LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti, LLC employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/D/V