Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
The Special Supplemental Benefits team has an exciting new opportunity within operations and escalations. This position plays a critical role in balancing the timely triage of special supplemental Medicare benefit, program and member escalations with a focus on following policies and procedures.
Want more jobs like this?
Get jobs in Louisville, KY delivered to your inbox every week.
This role will be responsible for:
- Performing the timely review of the Special Supplemental Benefit escalation cases to determine if the escalation is valid, perform all research, resolution, and documentation to successfully close the case
- Works cross functionally to find resolutions as cases may contain multiple issues and may require coordination of responses from multiple business units, including external vendors, for an accurate and complete resolution
- Appropriate documentation of escalation cases to support audits, the financial well-being of the benefit, as well as supporting member satisfaction
- Support departmental goals of maintaining process controls, adhering to benefit and program policies and procedures, and adhere to CMS guidance
- Generate daily reports of escalations for assignment and pull-down supporting documentation to aid in research
- Tracking and identifying trends as well as emerging issues and report and recommend solutions
- Identifying operational gaps and process improvement opportunities
- Point of contact for internal questions related to eligibility research
- Takes ownership of their work
Required Qualifications
- Medicare Individual, Group and/or Special Needs Plan or other health plan related experience
- Proficient and comfortable with navigating Microsoft Office products (Excel, Word, and Outlook) and other computer-based applications/programs
- Highly organized and detail oriented along with having strong research and problem-solving skills
- Strong interpersonal skills and the ability to work independently and in a team environment
- Strong written and verbal communication skills
- Time and priority management skills
- Analytical skills with the ability to multitask and perform assignments quickly, while focusing on quality
- Customer service experience. Keeping customer centered approach to problem solving and communicating while keeping business objectives and goals in-mind
- Experience in research and analysis of complaints/escalations
- CMS Flexibilities - VBID / SSBCI / UFCMS Flexibilities - Value Based Insurance Design (VBID), Special Supplemental Benefits for the Chronically Ill (SSBCI) and Uniform Flexibility (UF)
- Process management experience
- Bachelor's degree
- High School Diploma or equivalent experience
The typical pay range for this role is:
$54,300.00 - $119,340.00
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: 11/06/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.