Pharmacy Eligibility/Claims Business Analyst

CVS Health • New York, MA

2d • $54,300 - $145,860 • Hybrid

About The Position

This Scrum Team role is part of the Medicare / Medicaid / Exchange Enrollment Configuration team, which develops purpose-built capabilities for the NextGen platform. The Business Analyst delivers analysis and oversight requirements for Membership Integration and Reconciliation Stories within an Agile framework.

The position supports a hybrid work environment. If selected candidates live near a suitable work location, they may be expected to work onsite three days a week under the hybrid work policy. Aetna Service Operations office or hub locations will be discussed with the selected candidate.

Requirements

• 2–4 years of experience as a Business Analyst or equivalent supporting Medicare and Medicaid programs in an operational and/or technology context.
• 2–3 years of experience as a business analyst or project manager.
• 2–4 years of experience with PLSQL, SQL Server and/or Oracle, and SQL Server databases.
• 4–6 years of experience with software development lifecycles, including ownership of detailed analysis, data and process analytics, process improvement, process-flow creation, requirements gathering and traceability through the software delivery lifecycle, and post-production checkout or reviews.
• 4–6 years of experience with analytical techniques including scenarios and use cases, scope modeling, functional decomposition, interviews, observation or job shadowing, focus groups, acceptance and evaluation, sequence diagrams, user stories, brainstorming, storyboarding, prototyping, event analysis, business-rule analysis, requirements workshops, risk analysis, and root-cause analysis.
• Bachelor's degree or equivalent experience.

Nice To Haves

• Analytical experience supporting enrollment and eligibility platforms.
• Experience with pharmacy eligibility or claim transactions.
• 4–6 years of experience with software development lifecycles, contributing to estimation and resource planning, capacity planning, requirements gathering, testing framework and strategy, and post-implementation review.
• 2–4 years of experience with Medicare, Medicaid or Exchange Enrollment, and Pharmacy Operations.
• Intermediate leadership skills in creating accountability and developing and executing strategy.
• Foundational leadership skills in driving a culture of compliance.
• Advanced general business consulting skills for requirements gathering and documentation.
• Advanced leadership skills in anticipating and innovating.
• Advanced technology skills in justifying the business case.
• Experience with enterprise-wide and/or cross-functional large-scale initiatives with a high degree of complexity.
• Demonstrated experience successfully implementing change in complex organizations.
• Demonstrated senior-level relationship management skills, including the ability to quickly build and maintain credible relationships at varying organizational levels simultaneously.

Responsibilities

• Deliver analysis and oversight requirements for Membership Integration and Reconciliation Stories within an Agile framework.
• Support development of purpose-built capabilities for the NextGen platform as a member of the Medicare / Medicaid / Exchange Enrollment Configuration Scrum Team.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission or short-term incentive program in addition to base pay

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level