Blue Shield of California

Medical Informatics Analyst, Consultant - Pharmacy

Blue Shield of California  •  Oakland, CA (Hybrid)  •  3 hours ago
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Job Description

Your Role

The Pharmacy Financial Analytics team. The Medical Informatics Consultant will report to the Sr. Principal Medical Informatics Analyst of Pharmacy Financial Analytics. In this role, you will play a key part in advancing our organization's analytical capabilities by supporting network and rebate reporting, reconciliation processes, model development, and automation initiatives. Your work will directly empower leadership with the tools, insights, and data needed to make informed strategic decisions, drive operational excellence, and support the continued growth and success of the organization through innovative, data-driven solutions.

Your Work

In this role, you will:

  • Develop, optimize, and maintain complex SQL queries to extract, transform, and analyze pharmacy, claims, financial, and operational data.
  • Use SAS and other analytical tools to manipulate large healthcare datasets, support statistical analysis, and contribute to predictive model development.
  • Support the design, maintenance, and enhancement of underwriting tools used to evaluate pharmacy cost, utilization, revenue, and performance trends.
  • Design, automate, and maintain financial reporting to monitor pharmacy revenue streams, dispensing margins, rebate activity, billing accuracy, and key performance indicators.
  • Perform financial reconciliations across pharmacy claims, rebate, inventory, operational, and general ledger data to ensure accuracy, identify variances, and support issue resolution.
  • Analyze financial and operational trends to identify cost-saving opportunities, revenue impacts, process gaps, and business performance drivers.
  • Translate complex pharmacy and financial data into clear insights, recommendations, and presentations for business leaders and cross-functional partners.
  • Partner with Pharmacy, Finance, Underwriting, Actuarial, and operational teams to support strategic initiatives, improve reporting capabilities, and drive data-informed decision-making.

Your Knowledge and Experience

  • Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
  • Requires 7 years of relevant experience delivering analytics (cost, quality, utilization, and/or outcomes) with enterprise impact
  • Requires 5 years of prior pharmacy experience
  • Requires SAS Certified Advanced Programmer credential (or equivalent) or advanced analytics certification (e.g., R, Python)

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Blue Shield of California

About Blue Shield of California

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with nearly 6 million members, over 7,500 employees and more than $25 billion in annual revenue.

Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $60 million to Blue Shield of California Foundation in the last three years to have an impact on California communities.

For more news about Blue Shield of California, please visit news.blueshieldca.com.

Industry
Finance & Insurance
Company Size
5,001-10,000 employees
Headquarters
Oakland, California
Year Founded
1939
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