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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary
This Senior Analyst role performs claims diagnosis to identify claims impacted by plan benefit changes. This diagnosis is a vital step in the Service Warranty process which begins with reviewing the parameters of an issue and then running AS400 queries in order to identify the impacted claims. Depending on the type of case submitted, this position's daily tasks include pulling impacted claims to convert/submit for R&R and pulling impacted claims to complete a subsequent manual analysis in Excel. This work identifies and issues financial impacts to clients, members, and pharmacies due to benefit coding errors, eligibility changes, program features, and client requests.

This role is required to manage an individual queue of multiple projects in a fast-paced, process-driven environment and excellent communication and time-management skills. At times, the work completed will need to be presented and explained to other parties, both internal and external. A Senior Analyst would be expected to handle more complex SW submissions as well as batched submissions regardless of complexity. A senior member of the team would also take on responsibilities outside of the SW queue that benefit the team as a whole (training, reporting, documentation, collaboration, adhoc work stream, etc).

You will work closely with Sales, Account Management, Client Audit, Benefits, Clinical, Rebates, and other teams to manage and coordinate the work.

Required Qualifications

2+ years of healthcare experience

2+ years of Excel experience which includes the ability to manage and present large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.

Preferred Qualifications

·        Expert understanding of data sets, tables/files, queries, joins, and other database concepts 

·        Strong customer service focus that includes both internal and external customers.  

·        Excellent verbal and written communication skills. 

·        PBM Industry and plan design. RxClaim adjudication or benefits strongly preferred.  

·        Candidates that have CVS Caremark PBM adjudication/systems, LINKS/Mail order, AS400/mainframe, or other relevant experience are highly desired. 

·        Preferred experience includes business operational experience that includes high volume transactional experience. 

·        Highly desired Excel skills include ability to manage and present large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.

Education

Bachelor's Degree or equivalent work experience required.

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

This 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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/23/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.