Senior Analyst - Client Audit

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

CVS Health is currently looking for a dynamic individual to join our team in an Sr. Analyst role. This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking, reviewing, researching and assisting with multiple complex audit activities initiated by CMS / States. In this position, the Sr. Analyst will work closely with multiple clients and various Government / State auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business. This position needs to be able to manage many audits at the same time with short turnaround times. The Sr. Analyst will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations, formulary, and accumulation tracking in order to review and respond to all the auditor’s questions in a short window of time. This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions.   

As a Sr. Analyst of Client Audit, you will be responsible for the following:

• Work directly with the government auditors, the client and all the internal business areas involved in the audit

• Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities

• Work independently with limited direction from the Director

• Coordinate, manage, track the audits from start to closure

• Review and researching all questions from the auditor and client

• Work through and resolve any alleged issues; working strategically and achieving results

• Respond back to the auditor / client

• Raise appropriate at risk items to the Director timely

• Documenting correspondence with internal partners, clients, and auditors

• Tracking all audit progress to ensure that all deliverables are provided by due dates

The ideal candidate will possess the following:

• Understanding of pharmacy claim adjudication

• Understanding of pharmacy manufacturer rebates

• Ability to actively seek new ways to grow and be challenged

• Critical thinking which translates into strategic actions

• Easily adapting to change

• Excellent verbal and written communications skills

• Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion. A working contributor responsible for each project’s success.

• Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must. Strong tolerance for ambiguity and stress

• Strong ability to maintain attention to detail and organizational skills.

• Strong ability to hold oneself and others accountable for mitigating risk and achieving results.

Required Qualifications

3+ years of prior relevant experience in audit and/or project management
Preferred Qualifications

Project management experience.

Proficiency in Microsoft Word, Excel, PowerPoint.

PBM experience.

CPA, CIA, or MBA

Education

BS/BA required or equivalent years of education and experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/30/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.