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
The Non-MAC Appeals Team Associate is expected to demonstrate comprehensive expertise and a deep understanding of the non-MAC appeal process. Core responsibilities include thoroughly reviewing and processing appeals, verifying compliance with relevant regulations and organizational standards, and documenting each case with meticulous attention to detail. Associates must collaborate closely with colleagues and other departments to resolve challenging or complex cases, provide support and guidance to team members, and uphold consistency in the handling of appeals. The position is integral to maintaining the integrity of the appeals process, ensuring efficiency, and accuracy in all decisions made.

Responsibilities:

•Appeals and Mailbox Monitoring
Review and resolve pharmacy inquiries related to Non-MAC pricing appeals, ensuring compliance with MAC/NMAC law requirements.

•Data Validation & Source Verification
Validate pricing and product information using trusted sources such as Medispan, manufacturers, and wholesalers.

•Issue Escalation
Promptly escalate potential issues to leaders to minimize impact on pharmacies and plan members.

•Team Support & Training
Assist Non-MAC team by answering questions and providing training support as needed.

•IT Implementation Testing
Monitor and perform testing activities related to IT system implementations to ensure functionality and accuracy.

•Regulatory Inquiry Support
Assist in research for Department of Insurance (DOI) inquiries, providing accurate and timely information to DOI team.

•Ad Hoc Management Support
Provide assistance to management with various ad hoc tasks and special projects as assigned.

Required Qualifications
Pharmacy Benefit Management (PBM) experience with all non-MAC appeal related processes and 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 preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $40.90

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: 04/08/2026

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