The CMH Health Milliman practice is seeking a Pharmacy Benefits Analytics Manager with a strong background in managed care to work in a fast-growing area of the health practice. This role will involve accurately diagnosing client problems, developing project proposals, refining project strategy, outlining a project plan, managing internal resources, and presenting the results to the client. The Pharmacy Benefits Analytics Manager may assist clients such as employers, health plans, PBMs, and pharmaceutical companies.
Who We Are
Independent for 75 years, Milliman delivers market-leading services and solutions to clients worldwide. Today, we are helping companies take on some of the world’s most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation.
The health practice is a high-performing environment with multiple subject matter experts, who work together to solve complex problems related to pharmacy benefits, reimbursement, supply, and strategy.
Job Responsibilities
- Provide qualitative and financial evaluations of PBM contracts, including pricing and fee schedules
- Assist with developing models to conduct detailed analyses of pharmacy data, including pharmacy claims, eligibility data, etc.
- Acquire, standardize, and merge various data sets to provide summarized reports
- Contribute to drafting proposals, presentations, exhibits, RFPs, and reports
- Manage client relationships, projects, assignments, presentations, and deliverables
- Be able to work independently, but also actively lead teams utilizing pharmacy data expertise on various projects
Potential projects could include
- Trend Related Analysis
- Analyzing pharmacy data to provide solutions for cost-containment
- Milliman Health Cost Guidelines Pharmacy Research
- Medicare Part D, Medicaid, and Commercial Pharmacy Formulary Analysis
- Medicare Part D Fraud, Waste, and Abuse Monitoring
- Evaluation of New Product Pipeline (e.g., evaluating impact of agents for NASH, oncology drugs, etc.)
- Pharmaceutical Company Strategy Support (e.g., analytics to support formulary negotiations and modeling coverage gap discount program liabilities)
Minimum requirements
- Bachelor’s degree
- A minimum of four years of experience in the pharmacy benefits industry (ex. PBM, health plan, etc.)
- Extensive knowledge of pharmacy claims reimbursement (ex. WAC, AWP, discounts, rebates, etc.)
- Experience with handling large pharmacy claims datasets
- Experience creating models and reports focused on opportunities for formulary management, prior authorizations, drug pricing, etc.
- Strong business software capabilities, especially with Microsoft office tools (Excel) and data analysis technologies (SAS/SQL)
- Pharmacy technician certification preferred, but not required
Competencies and Behaviors that Support Success in this Role
- Analytical thinking and the ability to evaluate analyses for downstream impact
- Creative problem solving and analytical skills.
- Superior verbal and written communication skills
- Client focused and results oriented
- Ability to work independently and in a team environment
- Self-motivated, creative, and resourceful
The Team
Milliman is one of the leading experts in healthcare financing and delivery. We advise clients on a wide range of issues-from assessing the impact of healthcare reform on organizations or populations to streamlining operations while advancing the quality of patient care. Our consulting work is supported by a powerful toolkit of data analytics solutions and informed by the most trusted, comprehensive set of cost guidelines in the industry.
Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance.
Salary: The salary range is $85,000 to $135,000, depending on relevant factors, including but not limited to education, work experience, qualifications, skills, certifications, location, etc.
Location: It is preferred that this candidate work in-office at the Milwaukee, Chicago, or Harford office. Remote candidates will be considered.
Benefits
At Milliman, we focus on creating an environment that recognizes – and meets – the personal and professional needs of the individual and their family. We offer competitive benefits which include the following based on plan eligibility:
- Medical, dental and vision coverage for employees and their dependents, including domestic partners
- A 401(k) plan with matching program, and profit sharing contribution
- Employee Assistance Program (EAP)
- A discretionary bonus program
- Paid Time Off (PTO) starts accruing on the first day of work and can be used for any reason; full-time employees will accrue 15 days of PTO per year, and employees working less than a full-time schedule will accrue PTO at a prorated amount based on hours worked
- Family building benefits, including adoption and fertility assistance and paid parental leave up to 12 weeks for employees who have worked for Milliman for at least 12 months and have worked at least 1,250 hours in the preceding 12-month period
- A minimum of 8 paid holidays
- Milliman covers 100% of the premiums for life insurance, AD&D, and both short-term and long-term disability coverage
- Flexible spending accounts allow employees to set aside pre-tax dollars to pay for dependent care, transportation, and applicable medical needs
All qualified applicants will receive consideration for employment, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)