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Data Insights - Senior Advisor
CVS Health Corporation
Woonsocket, RI, United States
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Position Summary
The Data Insights - Senior Advisor will be responsible for improving payer exception management, ensuring payer contractual compliance, and for providing creative solutions to reducing costs. A key component of the role will be to perform forensic analysis on adjudication data to support strategic initiatives that advance data interchange and improve operational execution and patient outcomes. In addition, the role will leverage data visualization tools that will enable users to monitor results more readily and to leverage techniques that provide information in a quick and meaningful manner. The Senior Advisor will join a cross-functional team within retail pharmacy but will have interactions with payers, vendors, SSO’s and other business segments within CVS Health. This role will report to the Director of Network Performance, Payer Relations.
Job Responsibilities
• Support retail pharmacy partners with opportunities related to third party reject resolution
• Analyze Third Party payer rejection data and communicate findings in order to highlight opportunities for improvement
• Perform rigorous analysis and research to develop detailed insights of data to recommend business opportunities for enhancing payer responses
• Review proposed system changes and evaluate any possible negative impacts to contracting, claims processing and other existing system functionality
• Collaborate effectively with cross functional team on solutions and program development
• Key constituent in Payer Relations/Rx Ops relationship with a focus on activities impacting claims processing operations
Successful Candidates will Exhibit
• Outstanding analytical and problem solving skills
• Proven effectiveness in cross functional team working relationships
• Demonstrated success conducting complex quantitative analysis and building analytical models using Microsoft Excel
• Ability to communicate effectively and succinctly, both verbally and in writing via Microsoft PowerPoint
• Strong understanding of PBMs, drugs and the retail pharmacy landscape
• An open and honest communication style that quickly builds trust and respect
• Capacity to work independently and adapt to changing work priorities
• An entrepreneurial and high-energy self-starter who can easily function in a performance-driven environment
Required Qualifications
• 3+ years of experience working with PBM or Pharmacy adjudication services
• 3+ year of experience in contracting, claims processing and healthcare operations
• 2+ years of experience working with DW NCPDP and BI data mining tools
• 1+ year of experience working independently on an Enterprise cross-functional team
• 1+ years of experience with the NCPDP standard
Preferred Qualifications
• Advanced skills with Microsoft Office Suite; Particularly Excel and PowerPoint
Education
Bachelor’s Degree in related field or equivalent degree
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
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