Pharmacy Eligibility/Claims Business Analyst
PA · HybridFull-time$54–146K/yrPosted 1 day agoStill listed today
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At a glance
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Job overview
CVS Health is hiring a Pharmacy Eligibility/Claims Business Analyst for its Medicare, Medicaid, and Exchange Enrollment Configuration team. The role supports development of capabilities for the NextGen platform by analyzing and overseeing Membership Integration and Reconciliation stories within an Agile framework. The position may follow a hybrid or office-based arrangement for candidates near a suitable hub location.
Skills & qualifications
Skills
Qualifications
Benefits
Full 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: 11/07/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
How this job compares
Set against the 5,883 open Business Analyst jobs on Olive Jobs, counted November 4, 2026.
- Pay
- This posting$54–146K/yr
- Pennsylvania median$85–146K/yr115 salary ranges
- US median$87–146K/yr3,929 salary ranges
This range's midpoint, $100K, is 14% below the Pennsylvania median midpoint ($117K) — in the middle half of Business Analyst salary ranges in Pennsylvania.
- Openings
- Olive Jobs lists 213 open Business Analyst jobs in Pennsylvania and 5,883 across the US. 7% of them nationwide are listed as remote or flexible.
- Experience
- This posting asks for at least 4 years of experience; Business Analyst postings that state a minimum ask for 4 years at the median (4,642 postings).
- Education
- 2,370 of the 5,883 open Business Analyst jobs (40%) ask for a bachelor's degree or higher.
Counted across the open, public US postings on Olive Jobs on November 4, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.
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