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Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # Senior Data Analyst, Quality Review - Medicare... - **Company:** BlueCross BlueShield of North Carolina - **Location:** Oak Grove, NC, United States (Remote available) - **Experience:** Expert - **Salary:** $89,174.0 - $142,679.0 - **Contract:** Permanent contract - **Skills:** Microsoft Excel, Cloud Computing, Data Warehousing, Laboratory Information Management Systems, SQL Databases, Tools for Reporting - **Published:** June 16, 2026 - **Apply:** https://www.juju.com/job/00000000g8opbx ## About the Role + Bachelor's degree or advanced degree (where required) + 5+ years of experience in related field. + In lieu of degree, 7+ years of experience in related field. **Bonus Points** (Preferred Qualifications) + 5+ years of Medicare pharmacy claims, PBM, or managed care experience + Direct experience with **Medicare quality review, compliance, auditing, or PDE support** strongly preferredStrongexpertisein **Medicare Part D pharmacy claims adjudication** , including PDE requirements and CMS benefit rules + Working knowledge of **Medicare Part B drug billing** , HCPCS, andpharmacy-to-medicalclaim integration + Solid understanding of CMS regulations, including: + Cost-sharingand benefit phase logic + LIS and subsidy calculations + Formulary management and UM edits (PA, ST, QL) + Advanced analytical skills with experience performing claimanalysesanderror trending + Proficiencyin Excel; experience withprescription adjudicationsystemsandMedicare reporting tools preferred + Strong documentation, communication, andcross-functionalcollaboration skills + Pharmacy Technician certification or equivalent pharmacy background is a plus, Business Analysis, Business Data Analysis, Business Intelligence (BI), Cloud Applications, Code Collaborator, Communication, Consulting, Data Warehousing (DW), Health Insurance Industry, Peer Development, Problem Solving, Statistical Models, Structured Query Language (SQL) ## Description We're hiring a Senior Data Analyst to join the Government Pharmacy Programs Department! The Senior Data Analyst, Quality Review - Medicare Pharmacy Claims is responsible for ensuring accurate, compliant adjudication of Medicare Part D and Medicare Part B pharmacy claims. This role performs detailed quality oversight, validates benefit and pricing logic, ensures adherence to CMS regulations, and identifies systemic issues that impact claims accuracy, financial performance, and member outcomes., + Identify irregular prescribing and/or dispensing patterns for investigation and referral to PBM, internal audit and SIU teams + Review **Part B drug claims** for correct HCPCS coding, units of service, allowable charges, and coordination with medical claims + Identify claim adjudication errors related to pricing, benefit configuration, formulary status, utilization management edits, and CMS rules + Partner with Compliance to ensure claims accuracy consistent with **CMS guidance** , Medicare manuals, and plan sponsor requirements + Support internal and external audits (CMS program audits, CTM, PDE validation, RADV support activities) by identifying findings, impact analysis, remediation documentation, and Corrective Action Plans + Conduct root cause analysis on quality findings; partner with Compliance, IT, operations, and PBM teams to implement corrective actions + Develop and maintain quality metrics, dashboards, and trend reports related to Medicare claims accuracy and risk + Serve as a subject matter expert for Medicare pharmacy claims processing + Provide guidance and mentorship to peers and colleagues, and contribute to Medicare-specific quality standards, SOPs, and training materials ## Related Videos - [Green Cloud Computing](https://www.wearedevelopers.com/videos/592-green-cloud-computing) - [In-depth .NET Azure Functions: Isolated mode, performance and durable AI agents](https://www.wearedevelopers.com/videos/100207-in-depth-net-azure-functions-isolated-mode-performance-and-durable-ai-agents) - [Fault Tolerance and Consistency at Scale: Harnessing the Power of Distributed SQL Databases](https://www.wearedevelopers.com/videos/1146-fault-tolerance-and-consistency-at-scale-harnessing-the-power-of-distributed-sql-databases) - [Blueprints for Success: Steering a Global Data & AI Architecture](https://www.wearedevelopers.com/videos/1577-blueprints-for-success-steering-a-global-data-ai-architecture) - [Fault Tolerance and Consistency at Scale: Harnessing the Power of Distributed SQL Databases](https://www.wearedevelopers.com/videos/1520-fault-tolerance-and-consistency-at-scale-harnessing-the-power-of-distributed-sql-databases) - [WebAssembly: The Next Frontier of Cloud Computing](https://www.wearedevelopers.com/videos/972-webassembly-the-next-frontier-of-cloud-computing) ## Related Articles - [Data Analyst Salary in the UK](https://www.wearedevelopers.com/magazine/278-data-analyst-salary-in-the-uk) - [Data Analyst Salary Germany](https://www.wearedevelopers.com/magazine/277-data-analyst-salary-germany) - [Data Analyst Salary in Switzerland](https://www.wearedevelopers.com/magazine/276-data-analyst-salary-in-switzerland) - [Best Companies to Work For in Germany: Top 25 Companies in 2023 ](https://www.wearedevelopers.com/magazine/33-best-companies-to-work-for-in-germany-top-25-companies-in-2023) - [Best Companies to Work For in Berlin: Top 14 Companies in 2023 ](https://www.wearedevelopers.com/magazine/188-best-companies-to-work-for-in-berlin-top-14-companies-in-2023) - [Data Engineer Salary UK](https://www.wearedevelopers.com/magazine/253-data-engineer-salary-uk)