Network Pricing Management Senior Analyst

About the role

This position will be working with a team responsible for quality assurance reviews of client and pharmacy pricing execution for CVS Health, a Fortune Company. The Sr. Analyst ensures quality assurance for all client pricing implementations by auditing outputs from teams across Employer, Health Plan, and Government segments. Responsibilities cover all delivery systems and adjudication platforms related to pharmacy claims adjudication.

Responsibilities

• Inspect the correct application of business rules, implementation processes, network structures, and pricing documents.
• Operational support for the QA/QC process by reviewing upstream work outputs (e.g., Network Implementation forms).
• Downstream post-production review (e.g., AS400 network profile coding validations).
• Processing/running any number of tasks and jobs to support production (e.g., macros).
• Additional coding for state regulations.

Requirements

• 3-5 years of operational experience within PBM or Health Care industry.
• Ability to meet strict deadlines in a volume heavy environment.
• Intermediate to advanced proficiency in MS Office Suite of tools; Advanced proficiency in Excel and Access desired.

Qualifications

• Quality assurance audit experience.
• Knowledge of CVS Caremark network programs and procedures, including knowledge of retail pharmacy operations and claims adjudication proficiency.
• Fundamental project management knowledge and/or demonstrable experience.
• Intermediate to advanced interpersonal skills as demonstrated by successful collaboration to achieve common and shared goals across business teams.
• Strong time management skills, evidenced by experience being accountable to multiple deliverables on staggered deadlines.
• Effective communication skills in both formal and informal written communications and speech at all levels of an organization.
• RxClaim system experience.

Skills

• Intermediate to advanced proficiency in MS Office Suite of tools; Advanced proficiency in Excel and Access desired.

Benefits

The typical pay range for this role is $46,988.00 - $102,000.00. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.