- Pay Range for California: $123090.00 to $184800.00
- Pay Range for Bay Area: $138756.00 to $208320.00
- Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.
- Role can be filled by a candidate requiring sponsorship: No
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
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.
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.
