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Managed Care Analytics - Senior Analyst

at CVS Health

Posted: 3/13/2020
Job Reference #: 917541BR
Keywords: financial

Job Description

Job Description
The Senior Analyst - Managed Care Analytics reports to the Third Party Plan Benefits Manager and is responsible for the identifying opportunities that will improve the current adjudication process and patient outcomes, by utilizing breakthrough systemic technology. The Senior Analyst - Managed Care Analytics will research Third Party programs, analyze large data and apply critical thinking to resolve systemic issues that interfaces with stores, providers, patients, PBMs, pricing and financial impacts to the company. The functionality provides endless opportunity that can provide a positive impact on our stores and patients. Additionally, the analyst will identify innovative, systemic opportunities to improve the existing functionality, which includes assisting in writing system requirements, creating UAT test cases, executing UAT test cases and implementation strategy for new functionality.

1. Identifying Third Party Benefit opportunities by analyzing large data relative to claims adjudication responses, both rejections and paid transactions to improve patient outcomes.
2. Utilize existing system functionality to prompt store users to better patient outcomes, along with helpful messaging and/or instructions.
3. Identify new system functionality/trigger attributes to improve the system capabilities and automate specific store actions performed on a daily basis.
4. Testing of new functionality and trigger conditions within UAT environments, as well as help coordinating store rollout plans
5. Analytics to track the success of the edits/new functionality, once implemented

Required Qualifications
2 or more years of pharmacy retail store experience


3 or more years of analytical experience

Preferred Qualifications
5 or more years of pharmacy/claims adjudication experience.

Verifiable High School diploma or GED is required. Bachelors degree preferred.

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking Advice and Counsel

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

Application Instructions

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