Data Analyst III, PBM Business and Operations

ABOUT THE ROLE

We are seeking a full-time Business and Operations Analyst III to join our Data & Insights team. In this role, you’ll be responsible for creating data analyses that demonstrate our company’s impact to clients and strategic partners in the PBM space. You will support the development and execution of analytics, provide data-driven strategic insights, and create customized analytic approaches in a pharmacy benefits setting.

This role supports Rightway’s clinical delivery, operations, and other internal departments by developing and delivering complex analytical needs, including quarterly performance reviews and ad hoc client inquiries. Additionally, as a Business and Operations Data Analyst III, you will support strategic decision-making processes to optimize our PBM services.

• 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.
• Develop analytic frameworks and methodologies to support strategic initiatives and enable data-driven operational improvements.
• Translate complex data findings into clear, actionable insights using reports, dashboards, and presentations tailored to a range of stakeholders.
• Partner with internal teams to identify and evaluate opportunities for AI and automation in PBM operations and support implementation planning.

• Bachelor’s degree in Analytics, Computer Science, or related field, or equivalent work experience.
• 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.
• 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.
• Proven ability to guide standards and provide leadership and mentorship to junior team members.

• Proficiency in statistical software (Python, R).
• Proficiency with dbt.
• Experience with version control.
• Hands on AWS experience is a plus.

BASE SALARY: $100,000 - $135,000

Offer amounts for both remote and in office roles are influenced by geographic location.

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