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Job Title :
Medical Claims Analysis, Advisor
Job ID :
Location :
IL - Northbrook, NC - Greensboro, RI - Lincoln, RI - Woonsocket
Street Address :
695 George Washington Hwy
Category :
Description :
Job Description
In this highly visible and innovative position, you will use your strong industry knowledge as well as your strong analytical experience to lead Specialty analytic initiatives through analyzing medical and pharmacy claims data identifying key opportunities for our clients; providing oversight of detailed reporting; integration of new product offerings, as well as ad hoc analysis and reporting.

This position is a full cycle analytical role that will allow you to see a project all the way through from loading the data, reviewing it, analyzing the data, interpreting the data and presenting key findings back to the client.

Your client presentations will include strategic recommendations based on your analytical findings.

You'll use best practices and knowledge of analytics to solve complex business problems and differentiate the department’s analytics within the organization and the market


Required Qualifications
To qualify for this position, candidate must have a minimum of 5 years experience interpreting and analyzing medical claims data (will consider pharmacy claims experience as well)· to identify key issues and opportunities for clients.

This requires developing visual analytics, product & industry knowledge, and a thorough profile of clients.

Candidates must also have demonstrated experience in the following:

Expertise in packaging impactful findings and presenting them to internal stakeholders, external clients, and leadership.

Expertise in developing assumption based models to explore scenarios for clients, products, and pricing.

Advanced expertise in SAS, SQL or similar programming language, advanced Microsoft skills (Excel, Access)

Fully proficient in leading analytic initiatives for internal/external customers and executives.

In depth knowledge and experience in managed healthcare, preferably PBM or Health Plans


Preferred Qualifications

Works independently, receives minimal guidance.

Liaison to subject matter experts across the organization where collaboration is critical to producing well vetted results

Demonstrated capabilities in leading staff and serving as a resource for colleagues with less experience

·Bachelor's degree in Computer Science, Business, Analytics or related major.

·Master’s Degree strongly preferred.

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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Our culture

CVS Health core values of Innovation, Collaboration, Caring, Integrity, and Accountability not only support our purpose of helping people on their path to better health for our customers and patients, but they also apply to how we support our more than 250,000 colleagues. You will find our culture at CVS Health, and our leaders encourage personal and professional growth.

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