Pharmacy Eligibility/Claims Business Analyst

<p>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.</p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p><b>Position Summary</b><br /><span style="color:#000000">This is a Scrum Team role that will be a member of the Medicare / Medicaid / Exchange Enrollment Configuration team tasked with developing purpose-built capabilities for our NextGen platform. This role is responsible for delivering analysis and requirements of oversight for various Membership Integration and Reconciliation Stories within an Agile framework. </span><br /><br /><b>Required Qualifications</b></p><p style="color:!important"><span style="color:#000000">2-4 years of experience as a Business Analyst (or equivalent) supporting Medicare and Medicaid programs in an operational and/or technology context  </span></p><br /><p style="color:!important"><span style="color:#000000">2-3 years experience as a business analyst/project manager </span></p><p><br />2-4 years <span style="color:#1d2d3e">experience with PLSQL, SQL Server and / or Oracle, SQL Server databases </span></p><br /><p><span style="color:#1d2d3e">4-6 years experience with software development lifecycles, having owned: detailed analysis (data / process analytics, process improvements, process flow creation, requirements gathering, requirements traceability through the software delivery lifecycle, including post-production checkout / reviews. </span></p><br /><p><span style="color:#1d2d3e">4-6 years experience with extensive analytical techniques (Scenarios and Use-cases, Scope Modeling, Functional Decomposition, Interviews, Observation / Job Shadowing, Focus Groups, Acceptance and Evaluation, Sequence Diagrams, User Stories, Brainstorming, Storyboarding, Prototyping, Event Analysis, Business Rule Analysis, Requirements Workshops, Risk Analysis, Root Cause Analysis) </span><br /><br /><b>Preferred Qualifications</b><br /><span style="color:#000000">Analytical experience supporting enrollment and eligibility platforms. </span></p><p><span style="color:#000000">Experience with Pharmacy eligibility/claim transactions </span></p><p><span style="color:#000000">4-6 years experience with software development lifecycles, having contributed to estimation (resource planning), capacity planning, requirement gathering, testing framework and strategy, and post implementation review. </span></p><p><span style="color:#000000">2-4 years experience with Medicare, Medicaid or Exchange Enrollment, and Pharmacy Operations </span></p><p><span style="color:#000000">Leadership / Creating Accountability (Intermediate) </span></p><p><span style="color:#000000">Leadership / Developing and Executing Strategy (Intermediate) </span></p><p><span style="color:#000000">Leadership / Driving a Culture of Compliance (Foundational) </span></p><p><span style="color:#000000">General Business Consulting for requirement gathering and documentation (Advanced) </span></p><p><span style="color:#000000">Leadership / Anticipating and Innovating (Advanced) </span></p><p><span style="color:#000000">Technology / Justifying the Business Case (Advanced) </span></p><p><span style="color:#000000">Experience with enterprise-wide and / or cross-functional large-scale initiatives with high degree of complexity. </span></p><p><span style="color:#000000">Demonstrated experience successfully implementing change in complex organizations. </span></p><p><span style="color:#000000">Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously. </span></p><br /><p>**We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.  </p><br /><p>Aetna Service Operations office/hub locations will be discussed with the selected candidate.**</p><p> <br /><br /><b>Education</b><br /><span style="color:#1d2d3e">Bachelor's degree or equivalent experience </span></p><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b><span>Anticipated Weekly Hours</span></b></p>40<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b>Time Type</b></p>Full time<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left"><b>Pay Range</b></p><p style="text-align:left">The typical pay range for this role is:</p><p style="text-align:inherit"></p>$54,300.00 - $145,860.00<p style="text-align:inherit !important"></p><p style="text-align:left !important">This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. <br /> </p><p style="text-align:left !important">Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p style="text-align:inherit !important"></p><p><b>Great benefits for great people</b></p><p></p><p>We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.<br /><br /></p>This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<p><span style="color:#4a4a4a"><br />Additional details about available benefits are provided during the application process and on </span><a target="_blank" href="https://learn.bswift.com/cvshealth-mainland"><span style="color:#0000ff"><u>Benefits Moments</u></span></a><span style="color:#4a4a4a">.<br /><br /></span></p>We anticipate the application window for this opening will close on: 11/14/2026<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p style="text-align:left">Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p>