• Job Description

  Req#: R0645296
  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.
  
  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 set-up and overapplied accumulators by running reports from the claim processing system and conducting thorough audits.
  • Identifies and coordinates plan set-up 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 account-specific sessions.
  
  
  Required Qualifications
  
  • 2-4 years of experience with data analysis and/or auditing.
  • 2-4 years of experience in the healthcare industry.
  
  
  Preferred Qualifications
  
  • 1-2 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
  40
  
  Time Type
  Full time
  
  Pay Range
  
  The typical pay range for this role is:
  
  $18.50 - $42.35
  
  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
  
  We anticipate the application window for this opening will close on: 07/30/2025
  
  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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