Pharmacy Eligibility/Claims Business Analyst

CVS Health; Center Square (PA); Hybrid; USD 54,000 - 146,000; Full time

Job summary

CVS Health is seeking a Business Analyst to join the Medicare/Medicaid/Exchange Enrollment Configuration team. This role delivers analysis and requirements oversight for Membership Integration and Reconciliation stories within an Agile environment.

Hybrid work arrangement with onsite collaboration. The role emphasizes data-driven decision making, cross-functional teamwork, and contributions to the NextGen platform.

Qualifications

• 2-4 years of experience as a Business Analyst supporting Medicare/Medicaid programs in operational/tech context.
• 2-3 years experience as a business analyst/project manager
• 2-4 years experience with SQL Server and/or Oracle databases
• 4-6 years experience with software development lifecycles and requirements traceability
• 4-6 years experience with analytical techniques (use-cases, process modeling, interviews, etc.)

Responsibilities

• Deliver analysis and requirements oversight for Membership Integration and Reconciliation stories within an Agile framework.
• Collaborate with cross-functional teams to define data and process requirements.
• Assist in estimation, testing strategy, and post-implementation reviews.
• Support enrollment and eligibility platform initiatives with data-driven insights.

Skills

Medicare/Medicaid knowledge

Business analysis

SQL

PL/SQL

Data analysis

Education

Bachelor's degree

Tools

PL/SQL

SQL Server

Oracle

Job description

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.

Position Summary

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.

Required Qualifications

• 2-4 years of experience as a Business Analyst (or equivalent) supporting Medicare and Medicaid programs in an operational and/or technology context
• 2-3 years experience as a business analyst/project manager
• 2-4 years experience with PLSQL, SQL Server and / or Oracle, SQL Server databases
• 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.
• 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)

Preferred Qualifications

• Analytical experience supporting enrollment and eligibility platforms.
• Experience with Pharmacy eligibility/claim transactions
• 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.
• 2-4 years experience with Medicare, Medicaid or Exchange Enrollment, and Pharmacy Operations
• Leadership / Creating Accountability (Intermediate)
• Leadership / Developing and Executing Strategy (Intermediate)
• Leadership / Driving a Culture of Compliance (Foundational)
• General Business Consulting for requirement gathering and documentation (Advanced)
• Leadership / Anticipating and Innovating (Advanced)
• Technology / Justifying the Business Case (Advanced)
• Experience with enterprise-wide and / or cross-functional large-scale initiatives with high degree of complexity.
• Demonstrated experience successfully implementing change in complex organizations.
• Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.

• 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. Aetna Service Operations office/hub locations will be discussed with the selected candidate.**

Education

Bachelor's degree or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is $54,300.00 - $145,860.00
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.

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.

Great Benefits For Great People

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 11/14/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.