At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
As an Analyst - Quality, you will be part of Clinical Client Services QA team that is engaged across multiple functions including Benefits and Clinical Organization, with particular emphasis on solving problems, process improvement and increase automation opportunity within testing team. You will have the opportunity to utilize your communication skills and logical skills to analyze the business process, insert technology to solve problems and improve efficiency of Clinical testing operation. You will be responsible for performing analytical skill to review different Medicaid state compliance clinical programs and translate those into business rule and define test strategy and scripts to validate the same.
You will be responsible for driving all phases of clinical testing cycle from requirement gathering to closure. This team works closely with internal and external partners to deliver key strategic projects, manage applications and improve Client Services processes. You will actively participate on client calls. You will define Clinical test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders and seek approval.
To be successful you will bring your developed skills as an innovative, analytical, energetic, problem solver. You will be seen as a client problem-solver and will bring innovation solution for client requirements. If this describes you, then become part of our “go-to team”.
As an Analyst - Quality, you will own following responsibilities:
- Understanding client needs and Clinical requirements, translate into Test Scenarios to validate Clinical Configuration and Benefits Coding.
- Building relationships with key client partners through a consultative approach to fully understand clinical components of client benefit plan design needs
- Translating Client needs and requirements to internal CVS Health team such as Coding and Quality Analysis team.
- Providing timely communications to provide status updates and make decisions relative to client clinical set up.
- Expertise on EZTEST (claim processing tool), Sales force, EZQYERY, EXCEL Macro, Formulary management system and Benefit Serve/Benefit builder.
- Translate CMS and state mandate clinical program/rule and define business rule and validate before code promotion to production.
- Facilitating internal and external meetings and presentations to provide status updates and ensure Clinical configuration accuracy for Client’s requirement
- Define Clinical test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders.
- Develop process improvement initiatives in support of department efficiency. Pinpoint areas of opportunity and training needs.
- Work through the various phases of the project until all issues have been resolved, cleanup complete and all reportable items are closed to the satisfaction.
- Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround
Your success will be driven by exceeding client satisfaction score targets as well as working towards reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Claims Adjudication will also contribute to your success. You will operate in a dynamic environment with tight deadlines so ability to operate. The contributions you will make as a Analyst, Clinical client benefits will position CVS Health as a leader in Client Satisfaction and service in the Pharmacy Benefit Management Marketplace.
Required Qualifications
4+ years of Healthcare/Testing/PBM experience.
Preferred Qualifications
- Strong written and verbal Communication skills
- Demonstrated ability to manage and organize projects from start to completion
- Proficiency in Microsoft Excel
- Ability to work independently with little supervision
- Ability to work and communicate effectively with multiple departments and individuals.
- Be details oriented and have very good organizational skills.
Education
Bachelor’s degree with 4 yrs of IT experience. Equivalent experience can also be considered.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$43,888.00 - $85,068.00This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 06/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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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.
