Health Care Analyst (Pharmacy Benefits)

Title: Health Care Analyst (Pharmacy Benefits)

Location: Detroit, MI (Hybrid)

Duration: 12+ months

• The Healthcare Analyst supports Medicare Advantage plans in meeting CMS compliance, including PBM oversight, CMS reporting, member eligibility verification, and benefit setup/testing.
• Focuses on process improvement, customer service, and efficient reporting. Collaborates with internal and external teams, participates in CMS and internal audits, and aids in policy development and system testing.
• Identifies business challenges and implements solutions to drive operational efficiency and ensure compliance with regulatory standards.
• Develops and improves workflows to enhance customer service and reduce operational costs.
• Provides support to Customer Service, addressing inquiries with clear responses.
• Assists in CMS and internal audits related to pharmacy claims and eligibility data.
• Analyzes business problems, proposes solutions, and contributes to process improvements.
• Leads projects from initiation to completion, ensuring alignment with organizational goals.
• Communicates project results effectively within the organization.
• Implements policies and procedures to ensure corporate compliance with CMS and regulatory standards.
• Participates in system testing and provides recommendations for process improvements.
• Offers training and support to internal and external personnel to improve operational efficiency.
• Fosters effective relationships with customers and stakeholders to ensure smooth operations.

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