Business Analytics Associate

CVS Health

Springfield, Missouri, United States

Springfield, Missouri, United States

À propos

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
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).
2–5 years of experience in Pharmaceutical pricing or reimbursement.
2–5 years of experience in Healthcare compliance or regulatory affairs.
2–5 years of experience in Data analysis or financial modeling.
Education: Associate degree required.
Preferred Qualifications
Experience with RxClaim platform (AS 400).
SAS experience.
Bachelor’s Degree.
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The Typical Pay Range For This Role Is: $21.10 - $44.99. This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.
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.
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

Compétences linguistiques

English

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