Medical Informatics Analyst, Consultant - Pharmacy

Blue Shield of California; Oakland (CA); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Blue Shield of California is seeking a Pharmacy Financial Analytics professional to support network and rebate reporting, reconciliation, model development, and automation initiatives. You will provide leadership with data-driven insights to drive operational excellence and strategic decisions.

The role requires strong SQL, SAS, and data manipulation skills, plus experience with healthcare datasets and collaboration across Pharmacy, Finance, Underwriting, and Actuarial teams.

Qualifications

• Bachelor's degree or High School Diploma with 4 years of relevant experience
• 7 years of analytics experience with enterprise impact
• 5 years of pharmacy experience
• SAS Advanced Programmer credential or equivalent analytics certification

Responsibilities

• Develop, optimize, and maintain complex SQL queries for pharmacy, claims, financial, and operational data
• Use SAS and other tools to manipulate large healthcare datasets and support predictive models
• Support underwriting tools to evaluate pharmacy cost, utilization, revenue, and trends
• Design, automate, and maintain financial reporting for revenue, margins, rebates, billing accuracy, and KPIs
• Perform financial reconciliations across pharmacy data to ensure accuracy and resolve issues
• Analyze trends to identify cost savings and business drivers
• Translate data into insights and present to leaders and cross-functional partners
• Collaborate with Pharmacy, Finance, Underwriting, Actuarial, and operations teams

Skills

SQL

SAS

Data analysis

Healthcare analytics

Communication

Education

Bachelor's degree

Relevant experience in lieu of degree

Tools

SAS Advanced Programmer

R

Python

Job description

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.

Responsibilities

Your Work

• 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.

Qualifications

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.

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.