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

• 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. Assuming more complex groups and mentors Associate Plan Builder
• 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.
• Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements. Sr Analysts are assigned the more complex client plans and high profile clients.
• Uses critical thinking and extensive knowledge of Meritain's system and processes to evaluate impact of client requested exceptions and develops reasonable alternatives to satisfy client's needs while minimizing impact on Meritain's system and operations; Identifies, communicates and tracks cost sensitive items not included as part of the standard process and highlights them for consideration in the determination of rate adjustments or renewal activity.
• 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.
• Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans rather than standard offerings.
• Effectively manages implementation and provides direction to fellow team members ensuring success of overall implementation process. Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.
• Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)
• Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting.
• Reviews coverage files at intervals throughout the first year of implementation to analyze for setup adjustments to align with claim processing reports to achieve higher levels of auto adjudication opportunities.
• Mentors Associate Plan Builders.

• 2+ years of plan build experience required

• Meritain system experience
• Detail oriented
• Highly organized
• Good communication skills

• Bachelor's degree or equivalent work experience