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
This position will be working with a team that is responsible for quality assurance reviews of our client and pharmacy pricing execution of network and mail pricing for CVS Health, a Fortune Company.
The Sr. Analyst, you will ensure quality assurance for all client pricing implementations by auditing outputs from our teams across Employer, Health Plan, and Government segments. Your role covers all delivery systems and adjudication platforms related to pharmacy claims adjudication. You will inspect the correct application of business rules, implementation processes, network structures, and pricing documents.
Additional job tasks may include operational support for the QA/QC process by reviewing upstream work outputs (e.g. Network Implementation forms), downstream post production (e.g. AS400 network profile coding validations), processing/running any number of tasks and jobs to support production (e.g. macros), and additional coding for state regulations.
Being well-organized and deadline-focused, with the ability to make quick, efficient, and effective decisions, is crucial while working in a team and autonomous environment as a self-starter. Competency in MS Excel is essential for ad-hoc data analysis and reporting. Intermediate technical skills are key for utilizing department and company tools. This includes navigating Sarbanes-Oxley and SAS-70 environments and managing internal and external inquiries and responses. Strong interpersonal, relationship, and communication skills are essential to resolve daily challenges and maintain client satisfaction and revenue expectations.
Required Qualifications
3-5 years of operational experience within PBM or Health Care industry.
Ability to meet strict deadlines in a volume heavy environment.
Intermediate to advanced proficiency in MS Office Suite of tools; Advanced proficiency in Excel and Access desired.
Preferred Qualifications
Quality assurance audit experience.
Knowledge of CVS Caremark network programs and procedures, including knowledge of retail pharmacy operations and claims adjudication proficiency.
Fundamental project management knowledge and/or demonstrable experience.
Intermediate to advanced interpersonal skills as demonstrated by successful collaboration to achieve common and shared goals across business teams.
Strong time management skills, evidenced by experience being accountable to multiple deliverables on staggered deadlines.
Effective communication skills in both formal and informal written communications and speech at all levels of an organization.
RxClaim system experience.
Education
High School diploma, or equivalent experience (required); Bachelor’s degree or equivalent experience (preferred)
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $102,000.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 3-5 years of operational experience within PBM or Health Care industry.
- High School diploma or equivalent experience.
- Ability to meet strict deadlines in a volume heavy environment.
- Intermediate to advanced proficiency in MS Office Suite.
- Competency in Microsoft Excel for ad-hoc data analysis.
- Experience navigating Sarbanes-Oxley and SAS-70 environments.
- Strong interpersonal, relationship, and communication skills.
- Advanced proficiency in Microsoft Access.
- Quality assurance audit experience.
- Knowledge of CVS Caremark network programs, retail pharmacy operations, and claims adjudication.
- Fundamental project management knowledge or demonstrable experience.
- RxClaim system experience.
- Bachelor's degree or equivalent experience.
- Experience with AS400, running macros/VBA, and coding for state regulations.
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
