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Position Summary
CVS Health has an exciting new opportunity within the Grievances team in Scottsdale, AZ. As a Grievance Analyst, you will be responsible for ensuring Grievance resolutions address member concerns and are in accordance with Centers of Medicare & Medicaid Services (CMS) guidelines. This role is critical to ensuring high quality results, meeting department and CMS mandated TAT and mentoring caseworkers. As part of this role, you will be required to interact directly with clients and internal business partners and mentor caseworkers assigned to you for support.
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You will perform an end-to-end quality review of written grievances resolution letters and summaries that are drafted by the caseworkers and provide feedback to ensure department and CMS required quality objectives are met. Based on the outcome of case reviews, you will identify quality or productivity issues with individual caseworkers and work with them to develop a plan to help the caseworkers meet or exceed department standards. Additionally, you will support the needs of the department in multiple audit functions (CMS Program Audit, client requested mock audits, and 3rd party generated audits) that are a direct result of the quality process. The Grievance Analyst will also complete full root-cause analysis functions, provide process improvement recommendations across multiple internal business units and deliver interdepartmental training, all with the goal of improving the member experience. Lastly, this position will also include providing support to various operational teams within the Grievance department, as needed. This may include working grievance cases, final quality review, and supporting grievance triage and assignment.
To be successful in this role you will need to be proficient in navigating Microsoft Word and Excel, detail-oriented along with having strong research skills. A successful Analyst is receptive to constructive feedback and flexible in adapting to change while effective in planning, prioritizing, and organizing their time and workload to achieve turnaround time requirements. The Analyst must have excellent analytical skills, the ability to multitask and be able to perform reviews quickly, while focusing on quality. The Analyst will also need intermediate to advanced knowledge of various Caremark systems including MedHOK, PeopleSafe, the Source and RxClaim, and be able to navigate between systems throughout the review process.
Required Qualifications
- 2 plus years of experience working within a customer service role on several computer applications and complex databases for research, including Microsoft Office products (Excel, Word, and Outlook).
- Previous Med D grievance experience and advanced knowledge of grievance processes.
Preferred Qualifications
- Previous experience within Pharmacy Benefit Management (PBM) or pharmaceutical related industry.
- Bachelor's Degree Preferred
Education
High School Diploma or equivalent GED
Pay Range
The typical pay range for this role is:
$43,888.00 - $76,500.00
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 11/08/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.