Medicare Analytics Lead - PBM & Compliance

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 72,828 - 146,432; Full time

Job summary

CareFirst BlueCross BlueShield is seeking a Senior Business Analyst to drive critical Medicare pharmacy programs through advanced data analysis, reporting, and operational PBM oversight.

You will interpret complex data to build reports, ensure regulatory compliance, and support quality and performance goals across pharmacy operations. This role emphasizes cross-functional coordination with leadership and vendors.

Qualifications

• Bachelor's degree in Business, IT, CS, or related field; or 4 additional years of relevant work experience.
• 5 years of progressive experience in business analysis, systems analysis, testing, or similar analytical roles.

Responsibilities

• Analyze pharmacy operational data and claims to identify trends and improvement opportunities.
• Monitor claims processing and review PBM coding for accuracy and compliance.
• Perform PDE review, correction, and retraction activities.
• Prepare and submit Medicare KPI reports including PBM performance and compliance tracking.
• Provide analytical support and recommendations to pharmacy leadership for operational decisions.

Skills

Advanced data analysis

Reporting & dashboards

Stakeholder communication

Regulatory/compliance understanding

Education

Bachelor's degree in Business/IT/CS

Alternatively 4 years relevant work experience

Job description

CareFirst BlueCross BlueShield is seeking a Senior Business Analyst to drive critical Medicare pharmacy programs through advanced data analysis, reporting, and operational PBM oversight.

You will interpret complex data to build reports, ensure regulatory compliance, and support quality and performance goals across pharmacy operations. This role emphasizes cross-functional coordination with leadership and vendors.