Senior Business Analyst, Claims Diagnosis

5 days ago


Northbrook, Illinois, United States CVS Health Full time

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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