Pharmacy Eligibility/Claims Business Analyst

CVS Health Careers

. Serve as a Scrum Team member on the Medicare / Medicaid / Exchange Enrollment Configuration team .

Posted 10/30/2026full-timeBlue Bell • Pennsylvania • United StatesMid-LevelSenior💰 $54,300 - $145,860 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Business Analysis within Medicare and Medicaid programs, focusing on data and process analytics, requirements gathering, and software delivery lifecycle management. Proven ability to lead process improvements and contribute to strategic planning in complex organizational environments.

Highest-signal resume keywords

Business AnalysisMedicare And Medicaid ProgramsPL/SQL And SQL ServerRequirements GatheringProcess Improvements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

PL/SQLSQL ServerOracleSoftware Development LifecycleData AnalyticsRequirements TraceabilityProcess Flow CreationAnalytical TechniquesEstimation And Capacity PlanningTesting Framework

Soft Skills

Intermediate LeadershipRelationship ManagementCreating AccountabilityDeveloping And Executing StrategyDriving A Culture Of Compliance

Industry Keywords

Enrollment And Eligibility PlatformsPharmacy OperationsChange ImplementationCross-Functional InitiativesComplex Organizations

Tech Stack

Tools & technologies

OracleSQL

About the role

Key responsibilities & impact

Serve as a Scrum Team member on the Medicare / Medicaid / Exchange Enrollment Configuration team
Develop purpose-built capabilities for the NextGen platform
Deliver analysis and requirements oversight for Membership Integration and Reconciliation stories within an Agile framework
Own detailed data and process analytics, process improvements, process flow creation, requirements gathering, and requirements traceability through the software delivery lifecycle
Contribute to estimation, resource planning, capacity planning, testing framework and strategy, and post-implementation review

Requirements

What you’ll need

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 of experience as a business analyst/project manager
2-4 years of experience with PL/SQL, SQL Server and/or Oracle, and SQL Server databases
4-6 years of experience with software development lifecycles
Experience owning detailed analysis, data/process analytics, process improvements, process flow creation, requirements gathering, requirements traceability through the software delivery lifecycle, and post-production checkout/reviews
4-6 years of experience with extensive analytical techniques, including 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, and root cause analysis
Bachelor's degree or equivalent experience
Preferred: analytical experience supporting enrollment and eligibility platforms
Preferred: experience with pharmacy eligibility/claim transactions
Preferred: 4-6 years of experience contributing to estimation, capacity planning, requirement gathering, testing framework and strategy, and post-implementation review
Preferred: 2-4 years of experience with Medicare, Medicaid or Exchange Enrollment, and Pharmacy Operations
Intermediate Leadership / Creating Accountability
Intermediate Leadership / Developing and Executing Strategy
Foundational Leadership / Driving a Culture of Compliance
Advanced General Business Consulting for requirement gathering and documentation
Advanced Leadership / Anticipating and Innovating
Advanced Technology / Justifying the Business Case
Experience with enterprise-wide and/or cross-functional large-scale initiatives with a high degree of complexity
Demonstrated experience successfully implementing change in complex organizations
Demonstrated senior-level relationship management skills and ability to build and maintain credible relationships at varying organizational levels

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being