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Business Analytics Associate7505 Caremark, L.L.C. • Springfield, Missouri, United States
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XX

Business Analytics Associate

7505 Caremark, L.L.C.
  • US
    Springfield, Missouri, United States
  • US
    Springfield, Missouri, United States
Find similar jobs

About

Position Summary The MAC team is responsible for all aspects of MAC list maintenance. This includes creating new MAC lists and managing existing MAC lists, uploading MAC prices to the adjudication platform and all MAC related QC processes. The MAC team works closely with the Finance Guarantee team to help ensure client commitments are met by making MAC adjustments as appropriate. The MAC team is also responsible for reviewing and responding to all pharmacy MAC appeals and working with the Legal team to respond to any MAC related complaints from state agencies. In addition, the MAC team monitors pharmacy GER guarantees and making MAC adjustments as needed. The MAC team is also responsible for all MAC related reporting, including client and pharmacy reports.
Responsibilities
MAC Pricing Compliance & Inquiry Resolution
Review and resolve pharmacy inquiries related to Maximum Allowable Cost (MAC) pricing, ensuring compliance with MAC law requirements.
Data Validation & Source Verification
Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers.
Database Management & Timely Communication
Accurately update the Pharmacy Inquiry Database and ensure timely responses to pharmacies within established turnaround times (TAT).
Market Monitoring & Issue Escalation
Identify changes in marketplace conditions and promptly elevate potential issues to pharmacists to minimize impact on pharmacies and plan members.
Team Support & Training
Assist a team of coordinators by answering questions and providing training support as needed.
IT Implementation Testing
Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy.
Regulatory Inquiry Support
Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to state regulators.
Ad Hoc Management Support
Provide assistance to management with various ad hoc tasks and special projects as assigned.
Required Qualifications
2–5 years of experience in
Pharmacy benefit management (PBM)
Pharmaceutical pricing or reimbursement
Healthcare compliance or regulatory affairs
Data analysis or financial modeling
Education: Associate degree required
Preferred Qualifications
Experience with RxClaim platform (AS 400)
SAS experience
Bachelor's Degree
Additional Information Anticipated Weekly Hours:
40
Time Type:
Full time
Pay Range:
$21.10 - $44.99 per hour (base hourly rate or base annual full-time salary). This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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  • Springfield, Missouri, United States

Languages

  • English
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