Pharmacy Benefit Manager Data Analyst Meritain Health
Pharmacy Benefit Manager Data Analyst Meritain Health
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Job Description
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven 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.
Position Summary
The PBM Data Analyst performs prescription claim and accumulator audits verifies policy coverage assesses claim validity and communicates with PBM Pharmacy Benefit Manager vendors & client management teams. This person contributes to the efficient and accurate handling of prescription claims for reimbursement through knowledge of prescription benefits and effective communication skills.
Job Duties include (but not limited to):
- Initiates investigation of plan setup and overapplied accumulators by running reports from the claim processing system and conducting thorough audits.
- Identifies and coordinates plan setup corrections and updates.
- Identifies and coordinates adjustments for member accumulators.
- Audits HRA overages and coordinates adjustments for any impacted claims.
- Communicates with internal partners and PBM vendors addressing inquiries resolving issues and providing accurate information regarding prescription claims data and accumulator overages.
- Maintains electronic records updates information and ensures compliance with relevant policies and regulations.
- Assists with process improvements implementation to enhance efficiency and effectiveness.
- Provides a high degree of customer service to clients during claims reviews and similar accountspecific sessions.
Required Qualifications
- 24 years of experience with data analysis and/or auditing.
- 24 years of experience in the healthcare industry.
Preferred Qualifications
- 12 years of PBM experience.
- 5 years of experience with data analysis and/or auditing.
- Demonstrated proficiency in Microsoft Excel.
- Strong attention to detail.
- Ability to independently handle multiple assignments competently accurate and efficiently.
Education
High school diploma or GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 $42.35This pay range represents the base hourly rate or base annual fulltime 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 shortterm 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.
Nocost 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 anticipate the application window for this opening will close on: 05/12/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.
Required Experience:
Manager
Employment Type
Full-Time
