Business Analytics - Associate

CVS Health is dedicated to building a more connected and compassionate health experience. The Non-MAC Appeals Team Associate is responsible for reviewing and processing appeals, ensuring compliance with regulations, and collaborating with team members to maintain the integrity of the appeals process.

Responsibilities:

• Review and resolve pharmacy inquiries related to Non-MAC pricing appeals, ensuring compliance with MAC/NMAC law requirements
• Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers
• Promptly escalate potential issues to leaders to minimize impact on pharmacies and plan members
• Assist Non-MAC team by answering questions and providing training support as needed
• Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy
• Assist in research for Department of Insurance (DOI) inquiries, providing accurate and timely information to DOI team
• Provide assistance to management with various ad hoc tasks and special projects as assigned

Requirements:

• Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes and state regulations, and claims adjudication, including claims adjudication logic
• Experience with RxClaim platform (AS400)
• Proficient in Excel, Word, Salesforce, and Pharmacy Portal
• Ability to work under tight deadlines
• Strong mathematical problem-solving skills
• Familiarity with wholesaler invoices