Business Analytics Associate

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

Requirements:

• 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