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Position Summary As an Analyst - Quality, you will be part of Clinical Client Services QA team that is engaged across multiple functions including Benefits and Clinical Organization, with particular emphasis on solving problems, process improvement and increase automation opportunity within testing team. You will have the opportunity to utilize your communication skills and logical skills to analyze the business process, insert technology to solve problems and improve efficiency of Clinical testing operation. You will be responsible for performing analytical skill to review different Medicaid state compliance clinical programs and translate those into business rule and define test strategy and scripts to validate the same.You will be responsible for driving all phases of clinical testing cycle from requirement gathering to closure. This team works closely with internal and external partners to deliver key strategic projects, manage applications and improve Client Services processes. You will actively participate on client calls. You will define Clinical test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders and seek approval.To be successful you will bring your developed skills as an innovative, analytical, energetic, problem solver. You will be seen as a client problem-solver and will bring innovation solution for client requirements. If this describes you, then become part of our “go-to team”.

As an Analyst - Quality, you will own following responsibilities:

• Understanding client needs and Clinical requirements, translate into Test Scenarios to validate Clinical Configuration and Benefits Coding.

• Building relationships with key client partners through a consultative approach to fully understand clinical components of client benefit plan design needs

• Translating Client needs and requirements to internal CVS Health team such as Coding and Quality Analysis team.

• Providing timely communications to provide status updates and make decisions relative to client clinical set up.

• Expertise on EZTEST (claim processing tool), Sales force, EZQYERY, EXCEL Macro, Formulary management system and Benefit Serve/Benefit builder.

• Translate CMS and state mandate clinical program/rule and define business rule and validate before code promotion to production.

• Facilitating internal and external meetings and presentations to provide status updates and ensure Clinical configuration accuracy for Client’s requirement

• Define Clinical test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders.

• Develop process improvement initiatives in support of department efficiency. Pinpoint areas of opportunity and training needs.

• Work through the various phases of the project until all issues have been resolved, cleanup complete and all reportable items are closed to the satisfaction.

• Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround

Your success will be driven by exceeding client satisfaction score targets as well as working towards reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Claims Adjudication will also contribute to your success. You will operate in a dynamic environment with tight deadlines so ability to operate. The contributions you will make as a Analyst, Clinical client benefits will position CVS Health as a leader in Client Satisfaction and service in the Pharmacy Benefit Management Marketplace.

Required Qualifications

4+ years of Healthcare/Testing/PBM experience.

Preferred Qualifications

• Strong written and verbal Communication skills

• Demonstrated ability to manage and organize projects from start to completion

• Proficiency in Microsoft Excel

• Ability to work independently with little supervision

• Ability to work and communicate effectively with multiple departments and individuals.

• Be details oriented and have very good organizational skills.

Education

Bachelor’s degree with 4 yrs of IT experience. Equivalent experience can also be considered.

Pay Range

The typical pay range for this role is:

$40,600.00 - $85,100.00

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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 07/29/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.