Business Analytics - Associate

CVS Health

2d • $21 - $41

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Non-MAC Appeals Team Associate is expected to demonstrate comprehensive expertise and a deep understanding of the non-MAC appeal process. Core responsibilities include thoroughly reviewing and processing appeals, verifying compliance with relevant regulations and organizational standards, and documenting each case with meticulous attention to detail. Associates must collaborate closely with colleagues and other departments to resolve challenging or complex cases, provide support and guidance to team members, and uphold consistency in the handling of appeals. The position is integral to maintaining the integrity of the appeals process, ensuring efficiency, and accuracy in all decisions made.

Requirements

• Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes and state regulations, and claims adjudication, including claims adjudication logic
• Experience with RxClaim platform (AS400)

Nice To Haves

• Proficient in Excel, Word, Salesforce, and Pharmacy Portal
• Ability to work under tight deadlines
• Strong mathematical problem-solving skills
• Familiarity with wholesaler invoices

Responsibilities

• Appeals and Mailbox Monitoring Review and resolve pharmacy inquiries related to Non-MAC pricing appeals, ensuring compliance with MAC/NMAC law requirements.
• Data Validation & Source Verification Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers.
• Issue Escalation Promptly escalate potential issues to leaders to minimize impact on pharmacies and plan members.
• Team Support & Training Assist Non-MAC team by answering questions and providing training support as needed.
• IT Implementation Testing Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy.
• Regulatory Inquiry Support Assist in research for Department of Insurance (DOI) inquiries, providing accurate and timely information to DOI team.
• Ad Hoc Management Support Provide assistance to management with various ad hoc tasks and special projects as assigned.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 5,001-10,000 employees