[Hiring] Business Analytics Associate @CVS Health

Role Description

The Non-MAC team is responsible for reviewing and responding to all pharmacy Non-MAC pharmacy appeals and collaborating with the Legal team to respond to any Non-MAC related complaints from state agencies.

• Non-MAC Pricing Compliance & Inquiry Resolution: Review and resolve pharmacy inquiries related to Non-MAC pricing, ensuring compliance with Non-MAC law requirements.
• Data Validation & Source Verification: Validate pricing and product information using trusted sources such as Medispan and wholesaler information.
• Market Monitoring & Issue Escalation: Identify changes in marketplace conditions and promptly escalate potential issues to leadership to minimize impact on pharmacies and plan members.
• Team Support & Training: Assist the Non-MAC team contractors by answering questions and providing training support as needed.
• IT Implementation Testing: Back up lead tester by monitoring and performing testing activities related to IT system implementations to ensure functionality and accuracy as needed.
• Regulatory Inquiry Support: Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to the DOI team to submit to state regulators.
• Ad Hoc Management Support: Provide assistance to management with various ad hoc tasks and special projects as assigned.

Qualifications

• Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes, state regulations, and claims adjudication, including claims adjudication logic.
• Experience with RxClaim platform (AS400).
• Bachelor's Degree required.

Requirements

• Proficient in Excel, Word, Salesforce, and Pharmacy Portal.
• Ability to work under tight deadlines.
• Strong mathematical problem-solving skills.
• Familiarity with wholesaler invoices.

Benefits

• Comprehensive medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.