CrawlJobs Logo

Clinical Prior Authorization Analyst

https://www.cvshealth.com/ Logo

CVS Health

Location Icon

Location:
United States , Phoenix

Category Icon

Job Type Icon

Contract Type:
Employment contract

Salary Icon

Salary:

43888.00 USD / Year
Save Job
Save Icon
Job offer has expired

Job Description:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Data Analyst will be responsible for providing business analysis and development of analytic solutions supporting the Prior Authorization program. A successful candidate will develop a solid understanding of Prior Authorization’s programs and products and utilize data querying (SQL/Python) and visualization (Tableau) tools to advance business objectives. The Data Analyst will leverage advanced querying expertise and a high degree of attention to detail to translate complex data into clear, actionable insights that support data-driven decision-making.

Job Responsibility:

  • Providing business analysis and development of analytic solutions supporting the Prior Authorization program
  • Develop a solid understanding of Prior Authorization’s programs and products
  • Utilize data querying (SQL/Python) and visualization (Tableau) tools to advance business objectives
  • Leverage advanced querying expertise and attention to detail to translate complex data into clear, actionable insights

Requirements:

  • 1 Year experience with data extraction, reporting, and analyzing metrics
  • 1 year experience with MS Office Products, SAS and/or other analytical tools
  • Proficient with SQL and Python
  • Experience with data visualization tools such as Tableau to create dashboards for non-data users
  • Ability to effectively communicate and present to management team
  • Ability to prioritize tasks in order to meet deadlines and manage competing demands
  • Bachelors degree in related field or equivalent experience

Nice to have:

  • Experience with healthcare or PBM data
  • Experience working with cloud data
What we offer:
  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs

Additional Information:

Job Posted:
May 15, 2026

Expiration:
May 16, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Clinical Prior Authorization Analyst

Epic Payer Platform Operations Analyst

The Epic Payer Platform Operations Analyst is responsible for day‑to‑day adminis...
Location
Location
United States , Louisville
Salary
Salary:
Not provided
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 1+ years administering healthcare interoperability platforms (Epic, payer APIs/interfaces, or equivalent) or educational equivalent
  • 8+ Years of Experience with Agile Software Development Life Cycle
  • 8+ Years of Excellent communication, documentation, and cross‑functional collaboration skills
Job Responsibility
Job Responsibility
  • Support the operational administration of Epic Payer Platform (e.g., Interconnect/Bridge, Payer Platform Console, Payer data sharing configurations) including environment health checks, routine maintenance, upgrades/patching, and change control
  • Configure, test, and maintain payer‑to‑provider workflows: coverage discovery (eligibility), prior authorization, claims status, clinical data exchange, care gap notifications, formulary/benefit, and provider inquiry/response
  • Maintain and execute runbooks for deployments, failover, disaster recovery, and incident management
  • ensure auditable change records
  • Administer and monitor FHIR integrations (SMART on FHIR/OAuth2/OIDC) for Da Vinci/HL7 profiles (e.g., CRD, PAS, PDex, P2P), CARIN IG for Blue Button where applicable
  • coordinate token lifecycles and client registrations
  • Support EDI/X12 transactions (270/271 eligibility, 276/277 claim status, 278 prior auth, 834 enrollment where applicable, 835 remittance) and related translation/validation processes
  • Collaborate with interface teams to maintain API gateways, message queues, and secure connectivity (TLS, mutual auth, certificates, VPN tunnels)
  • track throughput, error rates, and latency
  • Triage and resolve operational issues with Epic Payer Platform integrations, including authentication failures, payload validation errors, throttling, and data mismatches
  • Fulltime
Read More
Arrow Right

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...
Location
Location
United States , Los Angeles
Salary
Salary:
88854.00 - 142166.00 USD / Year
lacare.org Logo
L.A. Care Health Plan
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
Job Responsibility
Job Responsibility
  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes
  • Consults across business operations, providing mentorship, and contributing specialized knowledge
What we offer
What we offer
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
  • Fulltime
Read More
Arrow Right

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...
Location
Location
United States , Los Angeles
Salary
Salary:
88854.00 - 142166.00 USD / Year
lacare.org Logo
L.A. Care Health Plan
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and ETL processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
Job Responsibility
Job Responsibility
  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes
  • Identifies areas where technical solutions would improve business performance
What we offer
What we offer
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
  • Fulltime
Read More
Arrow Right

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...
Location
Location
United States , Los Angeles
Salary
Salary:
88854.00 - 142166.00 USD / Year
lacare.org Logo
L.A. Care Health Plan
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
Job Responsibility
Job Responsibility
  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes
  • Consults across business operations, providing mentorship, and contributing specialized knowledge
What we offer
What we offer
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
  • Fulltime
Read More
Arrow Right

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...
Location
Location
United States , Los Angeles
Salary
Salary:
88854.00 - 142166.00 USD / Year
lacare.org Logo
L.A. Care Health Plan
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
Job Responsibility
Job Responsibility
  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes
  • Consults across business operations, providing mentorship, and contributing specialized knowledge
What we offer
What we offer
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
  • Fulltime
Read More
Arrow Right

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...
Location
Location
United States , Los Angeles
Salary
Salary:
88854.00 - 142166.00 USD / Year
lacare.org Logo
L.A. Care Health Plan
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
Job Responsibility
Job Responsibility
  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed
  • Perform other duties as assigned
What we offer
What we offer
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
  • Fulltime
Read More
Arrow Right

Authorization and Claims Analytics Data Analyst III

The Authorization and Claims Analytics Data Analyst III serves as a Subject Matt...
Location
Location
United States , Los Angeles
Salary
Salary:
88854.00 - 142166.00 USD / Year
lacare.org Logo
L.A. Care Health Plan
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's Degree (or equivalent education/experience)
  • At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health
  • Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights
  • Experience analyzing multiple data sources and translating findings into actionable recommendations
  • Experience with Utilization Management (UM) authorization workflows and prior authorization metrics
  • Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes
  • Advanced proficiency in Tableau (or equivalent BI tools)
  • Strong statistical and analytical skills, including multivariate analyses, regression, and control charts
  • Knowledge of version control (Git, GitHub) and collaborative development workflows
  • Ability to develop and maintain reusable analytic frameworks, templates, and processes
Job Responsibility
Job Responsibility
  • Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights
  • Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance
  • Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows
  • Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards
  • Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases
  • Maintains awareness of data lineage and governance compliance throughout all analytic work
  • Manages project planning, tracking, and post-implementation assessment for assigned deliverables
  • Mentors and models adherence to analytic development best practices
  • Applies subject matter expertise in evaluating business operations and processes
  • Identifies areas where technical solutions would improve business performance
What we offer
What we offer
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)
  • Fulltime
Read More
Arrow Right
New

Turkish Linguist Expert

Sigma is a leading global technology company specializing in data collection and...
Location
Location
Salary
Salary:
Not provided
sigma.ai Logo
Sigma AI
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree in Linguistics, Languages, Literature, or a related field
  • Linguist with native or near-native proficiency in Turkish
  • Fluent in English with the ability to accurately listen and write with excellent spelling and attention to detail
  • Solid command of linguistic theory, grammar, and language structure
  • Strong writing, editing, and communication skills
  • Computer literacy
Job Responsibility
Job Responsibility
  • Annotation
  • Audio/Video/Image/Sentence/Word validation
  • Categorization
  • Conversational interactions
  • Content creation
  • Correction
  • Evaluation
  • Localization
Read More
Arrow Right