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 As a Senior Analyst, Benefits Test, you will be part of an extremely talented team within our Aetna Benefits and Testing Client Services organization at CVS Health. You will be accountable for analyzing client requests and performing the necessary benefits testing and quality assurance. You'll work alongside BRMs, Benefits Coders and Testers, as well as our Account Management and Implementation teams to deliver high quality support to our vast number of clients. Extreme attention to detail is important for this role. Your testing and quality assurance activities will impact not only the federal and state programs that we participate in, such as Medicare Part D and Medicaid, but also the members we provide service to. As a Senior Analyst, Benefits Test, you will be accountable for creating a test strategy based on client intent and meeting or exceeding turnaround time and quality standards. You will research client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs. You will be expected to develop and execute high quality test cases and have clear understanding of the client intent to prevent issues leaking into production. Your tasks will include query and claim validation and raising internal defects for requirements not meeting the client intent. You will be required to work with the plan benefits coding team in resolving issues, driving expected results and meet project target dates as required by management. The Senior Analyst will also participate in root cause analysis discussions across multiple business units as required by Client Services leaders. You will work with Client Benefits, Account Management, and Implementation management along with senior leadership to improve the overall Quality of the Client Implementation experience. Our organization offers a benefit package including vacation and holiday paid time off, health/dental/vision insurance, work/life balance, employee discounted stock purchase program, 401K, tuition reimbursement, and employee discounts at all CVS stores. Check out all our benefits at CVS Health Total Rewards .Senior Analyst, Benefits Test responsibilities- Take ownership of the test artifacts and client reviews.
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- Support other test analysts by providing training, coaching, and counseling and providing in depth quality reviews.
- Provide subject matter expert (SME) oversight of operational issues and identify solutions to resolve process issues and operational gaps.
- BRM collaboration, asking right questions and develop the quality results.
- Share the daily or weekly test status with management.
- Escalate project risks and concerns to test management and other business partners and clients .
- Identify areas of improvement.
- Resolve issues, develop results, and meet project target dates.Required Qualifications- 5 years of related work experience required in data analysis, auditing, information systems, quality assurance or other related background.
- Previous work experience in a RxClaim applications, PBM, Medical Claims, Health Insurance, Pharmacy, or Benefits.
- Advanced Microsoft Excel skills for data analysis; proficient in using other Microsoft Office applications.
- Great Knowledge and experience with Quality Assurance and testing in healthcare domain with wide understanding of Manual and automated testing.
- Great investigating skills and attention to detail. Ability to define problems, collect data, establish facts, draw valid conclusions, and perform the necessary Root Cause Analysis.
- Able to thrive and be successful in a energetic, operational environment that is client-centric.
- Well organized and able to effectively prioritize work and meet the schedule.
- Proactively Identify schedule, project risks, and timely communicate the same to business partners and clients.
- Ability to communicate findings with team, leaders, business partners and clients.
- Self-motivated and focused on ensuring client intent is met.Preferred Qualifications- Great mathematical skills.
- Technical aptitude, comfortable working in database systems.
- Proactively identify opportunities to improve efficiency/quality.
- Able to deliver per the timelines.
- Effectively participate in RCA's and apply the 5-Why process.
- Work large / complex clients to ensure 100% test coverage and review for proper set-up that meets client intent.
- Mentor and coach other team members.
- Project Management skills
- Accountable for always maintaining your SalesForce.com (SFDC) queue.
- Regression Testing, Query Testing and AS400 experience preferred.
- Experience with data mining large datasets and critically analyzing for trends and accuracy.
- Auditing experience
- Able to serve in guidance role and effectively communicate with leadership team.
- Possess thorough understanding of Caremark site platform/system applications/products.
- Proficient in analyzing and executing clinical and non-clinical client work requests.
- Able to thrive and be successful in a productive, operational environment that is very client centric, where there is high variability between clients' plan designs.
- Demonstrated ability to make decisions on one's own initiative by applying sound judgment based on business principals and supporting data facts.
- Demonstrated ability to be accountable and independent. Results accountable and performs at a high level with minimal supervision.
- Self-motivated and detail oriented focused on ensuring client intent is met and minimizing financial exposure.
- Able to apply logical thinking and investigating skills to research claims issues, formulate a strategic approach to efficiently build plans by performing analysis, and then execute and validate the plan build.
- Able to seek out and find solutions on one's own initiative.
- Able to prioritize issues and operate in environment of regulatory compliance and audit.
- Well organized and able to effectively prioritize work.
- High level of attention to detail.
- Able to meet aggressive turnaround time standards and client performance guarantees coupled with excellent quality.
- Able to effectively work within a team.
- Flexible in adapting to change.
- Able to learn and apply increasingly complex concepts, policies, and procedures.
- Able to effectively plan, prioritize, organize time and workload, in an environment of cyclical volume.
- Bachelor's degree preferred/specialized training/relevant professional qualification/equivalent experience.EducationHigh School Diploma or equivalent GEDPay Range
The typical pay range for this role is:$46,988.00 - $102,000.00This 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.
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 HealthWe anticipate the application window for this opening will close on: 01/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.