CVS Health
CVS Health
CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.

Associate Business Analyst, Pharmacy Benefits - CVS Health Remote

Support pharmacy benefit operations at CVS Health by managing MAC pricing, appeals, guarantees, and compliance reporting. This role helps maintain accurate adjudication and meet client and regulatory commitments.

Description

  • Develop and maintain MAC lists
  • Upload MAC pricing to the adjudication platform
  • Complete quality-control checks for MAC data and processes
  • Partner with the Finance Guarantee team to support client commitments
  • Apply MAC adjustments when appropriate
  • Review and resolve pharmacy MAC appeals
  • Coordinate with Legal on MAC-related complaints from state agencies
  • Track pharmacy GER guarantees
  • Produce MAC reports for clients and pharmacies

Requirements

  • Two to five years of experience in PBM, pharmaceutical pricing or reimbursement, healthcare compliance or regulatory affairs, data analysis, or financial modeling
  • Experience with the RxClaim platform and AS400 is preferred
  • Associate degree or equivalent professional experience
  • Bachelor's degree is preferred

Benefits

  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Resources supporting physical, emotional, and financial well-being
  • CVS Health bonus, commission, or short-term incentive program

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