[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

• 4 years 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).

Requirements

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

Education

• Bachelor's Degree or equivalent combination of work and experience.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Pay Range

The typical pay range for this role is: $21.10 - $40.90. 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.