# Non-MAC Team Member

**Company**: CVS Health
**Location**: Work from home, AZ, AZ
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $21.10 - $40.90
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/AZ---Work-from-home/Business-Analytics-Associate_R0941447?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_64234ff3-58b

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Non-MAC team is responsible for reviewing and responding to all pharmacy Non-MAC pharmacy appeals and collaborating with the Legal team to respond to any Non-MAC related complaints from state agencies.

Responsibilities:

- Review and resolve pharmacy inquiries related to Non-MAC pricing, ensuring compliance with Non-MAC law requirements.

- Validate pricing and product information using trusted sources such as Medispan and wholesaler information.

- Identify changes in marketplace conditions and promptly escalate potential issues to leadership to minimize impact on pharmacies and plan members.

- Assist the Non-MAC team contractors by answering questions and providing training support as needed.

- Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy as needed.

- Research and respond to Department of Insurance (DOI) inquiries, providing accurate and timely information to the DOI team to submit to state regulators.

- Provide assistance to management with various ad hoc tasks and special projects as assigned.

Required Qualifications:

- 4 years Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes, state regulations, and claims adjudication, including claims adjudication logic Experience with RxClaim platform (AS400)

Preferred Qualifications:

- Proficient in Excel, Word, Salesforce, and Pharmacy Portal

- Ability to work under tight deadlines

- Strong mathematical problem-solving skills

- Familiarity with wholesaler invoices

Education:

- Bachelor's Degree or equivalent combination of work and experience

Anticipated Weekly Hours: 40 Time Type: Full time

Pay Range: $21.10 - $40.90

Benefits: 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.

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## Skills

### Required
- Pharmacy Benefit Management
- RxClaim platform
- AS400

### Nice to have
- Excel
- Word
- Salesforce
- Pharmacy Portal
- mathematical problem-solving
- wholesaler invoices

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/AZ---Work-from-home/Business-Analytics-Associate_R0941447?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)