Pharmacy Benefit Research Analyst

The Division of Insurance is committed to creating and sustaining a work culture that is welcoming, inclusive, and mutually respectful to all its employees regardless of race, color, age, creed, religion, national origin, ethnicity, sex, gender identity or expression, sexual orientation, genetic information, veteran or disability status. We strive to reflect diversity in all facets and levels of our agency. The Division of Insurance values inclusiveness and diversity within their employee and management teams. Within our community we strive to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

The Division of Insurance is committed to ensuring a diverse and inclusive workplace where all employees feel respected, valued, and empowered to maximize their skills and talents to serve our citizens.

About the Role:

The basic purpose of this position is to conduct research in topics relevant to the Health Care Access Bureau's oversight and licensing of Pharmacy Benefit Managers and coordination of Mental Health Parity research and reporting, The Research Analyst will also assist with the monitoring of health insurance utilization, costs and rating, with special emphasis on pharmaceutical benefits in market health plans; to analyze data and information needed for the oversight of affordable health benefits; and to develop information to disseminate to consumers about health insurance benefits and access to affordable health products.

The health care research analyst will report to the Deputy Commissioner in charge of the Health Care Access Bureau, and will work closely with staff from the Financial Analysis, Market Analysis and Legal areas of the Division in the licensing of Pharmacy Benefit Managers, and will research the regulation of Pharmacy Benefit Managers and Mental Health Parity in other states or jurisdictions.

The health care research analyst will also assist other Health Care Access Bureau staff in conducting studies of the availability of pharmaceutical and behavioral health coverage, and will work with staff to determine the methods and procedures to be used in collecting data, will assist in coordinating the collection of data from health carriers, pharmacy benefit managers, behavioral health managers and health providers; will review submitted data carefully to ensure that it is reported consistently among all reporters; will assist in the identification of trends in submitted data and in the development of related recommendations for the Deputy Commissioner. The health care research analyst will also draft regular reports; collect and compare information from various reference sources and/or coordinate contracts with consulting actuaries and other consultants that may be incorporated in Health Care Access Bureau reports.

Duties and Responsibilities:

• Assists in formulating research objectives and conducts research in an assigned subject area to obtain the required information, and prepares reports based on results of research.

• Works with HCAB staff to determine the methods and procedures to be used for collecting data, including the development of data collection instruments.

• Analyzes research results to draw conclusions and make appropriate recommendations.

• Prepares written reports of research findings in accordance with established protocols, including the use of charts, graphs and tables.

• Collects information from various reference sources and consults with experts in various fields of knowledge in order to complete assigned work.

• Performs related duties such as maintaining files and records and attending meetings.

• Reviews reports for accuracy, completeness and content.

• Oversees and monitors assigned research activities in order to ensure effective operations and compliance with established standards.

• Assesses progress and effectiveness of assigned research activities, and recommends changes as needed.

• Assists in planning and implementing research activities to ensure the availability of required information and data.

• Confers with management staff to determine work requirements, availability of resources and to develop research criteria and standards.

• Confers with agency personnel within other Division of Insurance units, including the Health Care Access Bureau, the Financial Analysis Unit, the Market Conduct Unit and the Legal Unit.

• Confers with personnel from external state agencies, including health care staff in the Office of Consumer Affairs, Executive Office of Health and Human Services, Group Insurance Commission and the Executive Office of Elder Affairs.

• Confers with personnel from other state insurance and health departments, and National Association of Insurance Commissioner staff, regarding health insurance issues.

• Confers with personnel from external federal agencies, especially the Centers for Medicare and Medicaid Services and the General Accounting Office.

• Confers with local, state, and federal legislative staff to explain trends in health insurance systems and the availability of products in the market.

Preferred Qualification:

• Knowledge of health insurance terms, concepts, laws and regulations.
• Knowledge of the methods and techniques used in the collection of research data.
• Knowledge of statistical research methods and procedures, and the terminology and standard abbreviations used in statistics.
• Knowledge of the methods and techniques of statistics, including means, medians, modes, standard deviations, binomial coefficients, multiple regression and multivariate analysis.
• Knowledge of the methods of technical and statistical report writing.
• Knowledge of the methods used in the preparation of charts, graphs, and tables.
• Competence in Excel®, Powerpoint®, Acrobat®, and Word® applications.
• Ability to understand, apply and explain the policies, procedures, specifications, standards, guidelines, laws, rules, and regulations governing the Health Care Access Bureau's activities.
• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations.
• Ability to gather information by examining records and documents.
• Ability to assemble items of information in accordance with established procedures.
• Ability to work accurately with names, numbers, codes and/or symbols.
• Ability to determine the proper format and procedure for assembling items of information.
• Ability to maintain accurate records.
• Ability to write concisely, to express thoughts clearly, and to develop ideas in logical sequence, and to communicate effectively.
• Ability to exercise sound judgment.
• Ability to supervise projects, including the planning of work according to the nature of the job to be accomplished, the capabilities of subordinates and available resources; controlling work through periodic

Qualifications Acquired on Job:

• Knowledge of policies, procedures, specifications, standards, guidelines, and rules governing the Health Care Access Bureau.
• Knowledge of the types and uses of agency forms.
• Knowledge of electronic data processing techniques such as applied to statistical analysis.
• Knowledge of the principles, practices and techniques of supervision.

Qualifications

First consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have (A) at least two (2) years of full-time, or equivalent part-time, administrative, professional or technical experience in work involving research, data analysis, compliance, records management or program administration, or (B) any equivalent combination of the required experience and the substitutions below.

Incumbents may be required to have a current and valid motor vehicle driver's license at a class level specific to assignment.

Substitutions:

I. A Bachelor's degree or higher in a related field may be substituted for the required experience.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.