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
- Provides plan benefit review, interpretation, and systematic setup essential for online viewing and processing related to Customer Service, Claims, Enrollment, Billing and Reporting in support of internal and external partners.
- Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans rather than standard offerings.
- Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements.
- Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients.
- Reviews benefit provisions to ensure compliance with state and federal mandates. Evaluation process may also include assessment of summary plan descriptions and other related documents prepared internally or externally by clients.
- Uses business knowledge and experience to make plan design and processing recommendations when working with Clients.
- Reviews benefit provisions to ensure compliance with state and federal mandates. Evaluation process may also include assessment of summary plan descriptions and other related documents prepared internally or externally by clients.
- Collaborates on review, analysis, and development of recommendations for the design of complex account and benefit structures based on customers' objectives and Meritain's system.
- Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.
- Solicits and assesses internal and external customer feedback to drive continuous quality improvement on the renewal process (ie. System tools, resources, etc.)
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Required Qualifications
- Hybrid- 3 days onsite Tuesday- Thursday 2 days remote
- 1-3 years experience working with healthcare (Quality, Claims, and or Plan Build preferred)
- 1 year Experienced with various data systems (DOS systems a plus)
- 1+ YearsMedical terminology knowledge
- 5+ years' experience working with healthcare (Quality, Claims, and or Plan Build preferred)
- Salesforce
- Ability to research and look beyond the first right answer to find the root of a concern
- Be highly organized and able to quickly prioritize multiple assignments with high quality results.
- Must have strong communication skills with the ability to express complex concepts in a clear and concise manner.
- High attention to detail and accuracy while focusing on overall project deliverables.
- Ability to remain flexible yet focused during stressful situations.
- Analytical and problem-solving skills
- Highschool Diploma or GED.
40Time Type
Full timePay Range
The typical pay range for this role is:$43,888.00 - $93,574.00This 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 peopleWe 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.