Rightway is seeking a Business and Operations Analyst III to create data analyses that demonstrate the company's impact to clients and strategic partners in the PBM space, support the development and execution of analytics, provide data-driven strategic insights, and create customized analytic approaches in a pharmacy benefits setting.
Requirements
- Proficiency with SQL, relational databases and database structures
- Experience in the pharmacy industry and understanding of PBM operations.
- Experience with data visualization tools (e.g., Tableau, Power BI, Metabase)
- 4-8 years of experience in quantitative analytics and conducting advanced analytic modeling for large pharmacy and clinical datasets.
- 5+ years of industry experience querying and analyzing pharmacy claims and clinical program data.
- Basic understanding of AI, Generative-AI, and Machine Learning frameworks.
- Proficiency in statistical software (Python, R).
Responsibilities
- Work cross-functionally with PBM operational teams including Eligibility and Claim Operations, Configuration, and Contact Center to deliver actionable insights and strategic recommendations that support operational goals.
- Refine and enhance data infrastructure and processes to improve the scalability and efficiency of PBM services.
- Leverage knowledge of PBM practices, adjudication logic, regulatory requirements, and industry trends to guide analytics and decision-making.
- Build tools and reporting capabilities to monitor claims and enrollment data for trends, anomalies, or processing variances, enabling operational teams to act on performance improvement opportunities.
- Design and maintain dashboards and monitoring solutions to track claims processing metrics, operational KPIs, and performance guarantee compliance.
- Create and manage standardized reporting for internal stakeholders and external clients to support daily operations, audits, and client reporting needs.
- Apply advanced statistical techniques to assess PBM program performance and build repeatable measures for operational effectiveness.
Other
- Bachelor’s degree in Analytics, Computer Science, or related field, or equivalent work experience.
- Experience gathering and documenting requirements from clients or the business.
- Ability to communicate analysis to business partners and clients both in writing and verbally.
- Excellent communication and interpersonal skills.
- Experienced with developing data tools, memos, and presentations to deliver data and insights to stakeholders.
