Analyst, Financial Operations

CVS Health•Hartford, CT

1d•$43,888 - $93,574•Onsite

About The Position

The Analyst role performs claims diagnosis to identify claims impacted by plan benefit changes. This diagnosis is a vital step in the Service Warranty process which begins with reviewing the parameters of an issue and then running AS400 queries in order to identify the impacted claims. Depending on the type of case submitted, this position's daily tasks include pulling impacted claims to convert/submit for R&R and pulling impacted claims to complete a subsequent manual analysis in Excel. This work identifies and issues financial impacts to clients, members, and pharmacies due to benefit coding errors, eligibility changes, program features, and client requests. This role is required to manage an individual queue of multiple projects in a fast-paced, process-driven environment and excellent communication and time-management skills are essential. At times, the work completed will need to be presented and explained to other parties. You will work closely with Sales, Account Management, Client Audit, Benefits, Clinical, Rebates, and other teams to manage and coordinate the work.

Requirements

1+ years of healthcare experience
1+ years of Excel experience

Nice To Haves

Understanding of data sets, tables/files, queries, joins, and other database concepts
Strong customer service focus that includes both internal and external customers.
Excellent verbal and written communication skills.
PBM Industry and plan design.
RxClaim adjudication or benefits strongly preferred.
Candidates that have CVS Caremark PBM adjudication/systems, LINKS/Mail order, AS400/mainframe, or other relevant experience are highly desired.
Preferred experience includes business operational experience that includes high volume transactional experience.
Highly desired Excel skills include ability to manage and present large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.

Responsibilities

Performs claims diagnosis to identify claims impacted by plan benefit changes.
Reviews the parameters of an issue and runs AS400 queries to identify impacted claims.
Pulls impacted claims to convert/submit for R&R.
Pulls impacted claims to complete a subsequent manual analysis in Excel.
Identifies and issues financial impacts to clients, members, and pharmacies due to benefit coding errors, eligibility changes, program features, and client requests.
Manages an individual queue of multiple projects in a fast-paced, process-driven environment.
Presents and explains work completed to other parties.
Works closely with Sales, Account Management, Client Audit, Benefits, Clinical, Rebates, and other teams to manage and coordinate work.