Summary
CVS Health is a healthcare company focused on creating a more connected, convenient, and compassionate health experience. The Business Analytics Associate will review and resolve pharmacy Non-MAC pricing inquiries and appeals, validate pricing data, monitor market conditions, support regulatory inquiries, assist with training, and perform IT implementation testing.
Responsibilities
- 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
Skills
- 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
- Proficient in Excel, Word, Salesforce, and Pharmacy Portal
- Ability to work under tight deadlines
- Strong mathematical problem-solving skills
- Familiarity with wholesaler invoices
Qualifications
Must Haves
- 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
Nice to Haves
- Proficient in Excel, Word, Salesforce, and Pharmacy Portal
- Ability to work under tight deadlines
- Strong mathematical problem-solving skills
- Familiarity with wholesaler invoices
Benefits
- CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility