Woonsocket, Rhode Island

Job Description
CVS Health is on a mission to transform healthcare. With a shared purpose to help people on their path to better health, we are finding new ways to care for our communities, leveraging our brick and mortar footprint of 10,000 stores. At the heart of this strategy are the 180,000+ store colleagues who build unmatched human connections with our customers every day. As we seek to simplify a complex healthcare system for the patients we serve, while delivering disruptive innovation at a rapid pace, thoughtful communications that engage, inspire, and activate our colleagues across multiple channels are increasingly essential.

As a member of the Network Operations Adjudication Performance team you will be responsible for facilitating effective solutions related to the adjudication and processing of pharmacy claims. The position will support existing vendor product improvement and new product development enabling data-driven strategic decision-making and identify new revenue opportunities.
The Network Solutions Analyst will work cross-functionally with both internal and external partners to inform, influence, and design solutions, technology, tools and processes that simplify prescription billing—thereby enabling access to care for our patients, simplifying processes for our colleagues, and delivering value to the enterprise. In this role, the position requires strong analytical, communication, and collaboration skills to be able to influence internal and external business partners.

Required Qualifications
3+ years of analytical experience within pharmacy, healthcare, managed care, or related field
• 2+ years of experience with pharmacy claims adjudication
• 2+ years of experience creating and delivering leadership-facing materials and PowerPoint presentations
• 2+ years of experience using advanced Excel, PowerPoint skills and other MS Office Applications
• 2+ years of experience working with pharmacy claim standards and product implementation

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
•Create solid business cases that determine the value and risks associated with expanding services or implementing new solutions/products, employing data analysis to discover new opportunities and monitor solutions.
• Be an advocate for the patient, identifying and implementing opportunities to reduce patient out-of-pocket expenditure at no cost to the enterprise, while promoting adherence and customer satisfaction.
• Work effectively with internal and external stakeholders on program development including diagnosis, solution development, analysis, implementation and management of new and existing initiatives and solutions related to data optimization and reject mitigation.
• Build compelling business cases that demonstrate the impact of new proposed prescription billing solutions, complete with a comprehensive value proposition.
• Prioritize, structure timelines, develop project plans, align stakeholders across multiple groups, and incorporate feedback into active workstreams
• Prepare materials and presentations in a way that can be easily understood by others who may not have the same background or expertise
• Attention to detail, strong drive to ensure the integrity of underlying data and reports
• Reports to the Sr. Advisor, Network Operations Adjudication Performance team, and plays an integral part in driving operational efficiencies and compliance for the enterprise while helping people on their path to better health.
Superior analytical and problem-solving skills
• High level of attention to detail and ability to manage multiple assignments
• Experience in documenting requirements and summarization
• Experience with administrative claims data such as pharmacy or medical claims
• Ability to communicate and influence mid-level managers (Director and above)

Bachelor's degree or equivalent relevant work experience is required

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Woonsocket, Rhode Island

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses


"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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