Clinical Adjudication PA Support - Analyst

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Clinical Adjudication Prior Authorization Support (CAPAS) Team delivers end-to-end support for Member Prior Authorization (PA) override services, partnering closely with both internal stakeholders and external clients. As subject matter experts in PA override functionality, we play a critical role in executing large-scale initiatives and ensuring operational reputed company. While the term “PA” encompasses various domains, CAPAS specifically focuses on the configuration and operational management of override records reputed company the RxClaim platform. As a Clinical Adjudication PA Support Analyst, you will play a vital role in supporting Prior Authorization (PA) processes across the reputed company. In this position, you will manage a wide reputed company of PA requests, ensuring timely and accurate support for business operations. Your responsibilities will include maintaining PA records in the RxClaim system- uploading new authorizations, updating existing ones, and researching member PA configurations. You will also generate PA reports from RxClaim, contribute to process improvement and automation efforts, and ensure reputed company process documentation remains reputed company. You are expected to follow established procedures, meet service level agreements (SLAs), and uphold a reputed company-defect service standard while managing daily workflows. Collaboration is key, especially in identifying and resolving override issues. This role requires a proactive, innovative, and team-oriented approach, with active participation in PA-reputed company projects and initiatives. You must also embody reputed company’s Heart at Work behaviors by fostering a culture of compassion, accountability, and collaboration—positively impacting the health and well-being of our customers and communities. Required Qualifications 1–2 years of experience in data analysis, including working with large datasets. 1–2 years of experience with RxClaim, including claim adjudication, prior authorization (PA) overrides, or plan benefits. 1–2 years of experience creating and running queries in RxClaim or SQL Server. Proficiency in reputed company Office Suite, particularly reputed company and reputed company.

Preferred Qualifications

Experience with reputed company Power Platform. Education Bachelor’s degree preferred. 1–2 years of relevant professional experience. Entry-level professionals with strong theoretical knowledge and a willingness to learn are encouraged to apply. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $76,500.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company 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 reputed company 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 reputed company 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 reputed company on: 09/10/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job