Pharmacy Benefit Manager Data Analyst, CVS Health

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Not provided

Salary:

18.50 - 42.35 USD / Hour

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Job Description:

The PBM Data Analyst performs prescription claim and accumulator audits, verifies policy coverage, assesses claim validity, and communicates with PBM (Pharmacy Benefit Manager) vendors & client management teams. This person contributes to the efficient and accurate handling of prescription claims for reimbursement through knowledge of prescription benefits and effective communication skills.

Job Responsibility:

Initiates investigation of plan set-up and overapplied accumulators by running reports from the claim processing system and conducting thorough audits
Identifies and coordinates plan set-up corrections and updates
Identifies and coordinates adjustments for member accumulators
Audits HRA overages and coordinates adjustments for any impacted claims
Communicates with internal partners and PBM vendors, addressing inquiries, resolving issues, and providing accurate information regarding prescription claims data and accumulator overages
Maintains electronic records, updates information, and ensures compliance with relevant policies and regulations
Assists with process improvements implementation to enhance efficiency and effectiveness
Provides a high degree of customer service to clients during claims reviews and similar account-specific sessions

Requirements:

2-4 years of experience with data analysis and/or auditing
2-4 years of experience in the healthcare industry

Nice to have:

1-2 years of PBM experience
5+ years of experience with data analysis and/or auditing
Demonstrated proficiency in Microsoft Excel
Strong attention to detail
Ability to independently handle multiple assignments competently, accurate, and efficiently

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
July 17, 2025

Expiration:
July 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Pharmacy Benefit Manager Data Analyst