At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

As a Specialty Benefits Analyst, you are responsible for analyzing client requests and performing the necessary specialty benefits coding and quality assurance activities. You’ll work alongside other benefit coders, testers, and quality assurance representatives, as well as our Account, Clinical Requirement Advisors, and implementation management teams to deliver high quality support to our clients. Attention to details is important for this role, as you’re coding and quality assurance activities will impact clients at CVS Health. This position is responsible for analyzing and evaluating changes for updating RxCLAIM and using Salesforce to work cases from a queue. You will be expected to execute with high level of accuracy, responsiveness, and reliability while performing job functions.

Primary Job Duties & Responsibilities:

Responsibilities

Follow policies and best practices relating to the job function by analyzing client requests, determine the best operational approach and install adjudication related drug lists in Salesforce and RxClaim/AS400.

Collaborate regularly with peers to audit, review and verify drug list coding and testing while utilizing various tools.

Analyze and evaluate changes related to specialty pricing and access

Meet all turnaround time and performance guarantees with excellent quality.

Capable of applying logical thinking to identify process improvement opportunities.

Handle requests in a timely fashion without being asked

Demonstrates ability to learn and apply increasingly complex concepts, policies, and procedures

Support team members by providing peer reviews

Essential Qualifications and Functions:

Knowledge of:

• Microsoft Office applications
• 2-3 years of direct work experience with PBM knowledge
• Advanced knowledge of AS400 / RxCLAIM platform, system application, and products
• Advanced SalesForce.com

Skill In:

• Time management, Organizing and prioritizing non-routine tasks

• Verbal and written communication
• Analysis and attention to detail
• Interpersonal and collaborative skills

Ability To:

• Prioritize work effectively and independently
• Experience analyzing and executing clinical and/or non-clinical work requests
• Ability to learn and apply increasingly complex concepts, policies, and procedures
• Flexible in adapting to change
• Customer focused

Preferred Qualifications:

Knowledge of:

• 1-2 years of related work experience

Skill in:

• Pharmacy Technician license

Ability To:

• Provide peer reviews

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.