Senior Analyst, Financial Operations

CVS Health•Scottsdale, AZ

1d•$46,988 - $112,200•Onsite

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 Senior Analyst, Financial Operations performs claims reverse and reprocessing (R&R) to address benefit coding errors, eligibility changes, program features, and client requests. This role manages both the Client Audit–submitted Service Warranty queue and the standard Commercial queue, supporting Commercial and Performance Guarantee clients with strict turnaround times and financial implications. Success in this role requires strong analytical judgment, organization, and accountability to prioritize, track, and complete work accurately with minimal oversight. This work is a critical part of the Adjustment and Service Warranty process, including resolving rejects and QA failures, securing required approvals, and closing cases accurately and on time to deliver financial impacts to members, clients, and pharmacies. The Senior Analyst independently assesses cases, determines the appropriate resolution path, and executes corrective actions based on established requirements. This activity affects millions of claims annually and has broad organizational impact. This role operates in a fast-paced, process-driven environment and requires strong ownership of an individual workload across multiple concurrent projects. The ideal candidate communicates status and risks clearly, stays organized under tight deadlines, and navigates client-sensitive work with a high degree of accuracy and follow-through. This role may also present completed work to internal and external stakeholders and contribute beyond assigned casework through training, reporting, documentation, and cross-team collaboration. Additional tasks associated with this position include: • Extract claim data from RxClaim • Analyze and research complex Service Warranty scenarios submitted by upstream partners • Run and troubleshoot macros at regular intervals for business-critical workflows • Summarize adjustment information and manipulate data into reports that reflect financial impact and details on an ad hoc basis • Coordinate closely with the Client Audit team to clarify submissions, resolve questions, and ensure cases are completed accurately and timely Analysts work closely with multiple internal departments such as Sales, Account Management, Client Audit, IT, Networks, Benefits, and Implementations to manage and coordinate the work.

Requirements

2+ years of healthcare finance experience
2+ years of utilizing advanced Excel skills
Ability to work independently, manage competing priorities, and maintain ownership of assigned casework
Strong customer service focus that includes both internal and external customers
Excellent verbal and written communication skills

Nice To Haves

PBM industry and plan design knowledge
RxClaim adjudication or benefits knowledge
PBM or claim adjudication experience
Proficiency in IBM AS400
Understanding of SQL or other querying tools
Understanding of data sets, tables/files, queries, joins, and other database concepts
Ability to program using Visual Basic for Applications or other automation tools

Responsibilities

Performs claims reverse and reprocessing (R&R) to address benefit coding errors, eligibility changes, program features, and client requests.
Manages both the Client Audit–submitted Service Warranty queue and the standard Commercial queue, supporting Commercial and Performance Guarantee clients with strict turnaround times and financial implications.
Independently assesses cases, determines the appropriate resolution path, and executes corrective actions based on established requirements.
Extract claim data from RxClaim.
Analyze and research complex Service Warranty scenarios submitted by upstream partners.
Run and troubleshoot macros at regular intervals for business-critical workflows.
Summarize adjustment information and manipulate data into reports that reflect financial impact and details on an ad hoc basis.
Coordinate closely with the Client Audit team to clarify submissions, resolve questions, and ensure cases are completed accurately and timely.
Present completed work to internal and external stakeholders.
Contribute beyond assigned casework through training, reporting, documentation, and cross-team collaboration.