Senior Business Analyst, Claims Diagnosis
5 days ago
Job Summary
This Senior Business Analyst role performs critical claims diagnosis to identify claims impacted by plan benefit changes. This diagnosis is a vital step in the Service Warranty process, which begins with reviewing the parameters of an issue and then running AS400 queries to identify the impacted claims.
Key Responsibilities
- Pull impacted claims to convert/submit for R&R and pull impacted claims to complete a subsequent manual analysis in Excel.
- Identify and issue financial impacts to clients, members, and pharmacies due to benefit coding errors, eligibility changes, program features, and client requests.
- Manage an individual queue of multiple projects in a fast-paced, process-driven environment.
- Communicate effectively with internal and external stakeholders, presenting and explaining work completed.
- Handle complex SW submissions and batched submissions, regardless of complexity.
- Take on responsibilities outside of the SW queue that benefit the team as a whole, such as training, reporting, documentation, collaboration, and ad-hoc work streams.
Requirements
- 2+ years of healthcare experience.
- 2+ years of Excel experience, including managing and presenting large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.
- Expert understanding of data sets, tables/files, queries, joins, and other database concepts.
- Strong customer service focus, including both internal and external customers.
- Excellent verbal and written communication skills.
- PBM Industry and plan design experience, with RxClaim adjudication or benefits strongly preferred.
- Candidates with CVS Caremark PBM adjudication/systems, LINKS/Mail order, AS400/mainframe, or other relevant experience are highly desired.
- Business operational experience with high-volume transactional experience.
- Highly desired Excel skills include managing and presenting large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.
Education
Bachelor's Degree or equivalent work experience required.
Benefits
CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, Employee Stock Purchase Plan, term life insurance, short-term and long-term disability benefits, and numerous well-being programs.
CVS Health
We are a leader in the healthcare industry, dedicated to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose guides our commitment to innovation and delivering solutions that make healthcare more personal, convenient, and affordable.
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