Business Analytics Associate
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 team is responsible for reviewing and responding to all pharmacy Non-MAC pharmacy appeals and collaborating with the Legal team to respond to any Non-MAC related complaints from state agencies.
Requirements
- Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes, 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
- Review and resolve pharmacy inquiries related to Non-MAC pricing, ensuring compliance with Non-MAC law requirements.
- Validate pricing and product information using trusted sources such as Medispan and wholesaler information.
- Identify changes in marketplace conditions and promptly escalate potential issues to leadership to minimize impact on pharmacies and plan members.
- Assist the Non-MAC team contractors by answering questions and providing training support as needed.
- Back up lead tester by monitoring and performing testing activities related to IT system implementations to ensure functionality and accuracy as needed.
- Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to the DOI team to submit to state regulators.
- Provide assistance to management with various ad hoc tasks and special projects as assigned.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
