Client Benefits - Analyst

CVS Health

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About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As a Test Analyst, you will be part of Government (Medicaid and Medicare) Benefit Client Services Testing team that is engaged across multiple functions including Benefits and Clinical Organization, with particular emphasis on solving problems, process improvement and increase automation opportunity within testing team. You will have the opportunity to utilize your communication skills and logical skills to analyze the business process, insert technology to solve problems and improve efficiency of Benefit testing operation. You will be responsible for performing analytical skill to review different Medicare federal compliance programs and benefit plans based on CMS Defined standards and translate those into business rule and define test strategy and scripts to validate the same. You will be responsible for driving all phases of Benefit testing cycle from requirement gathering to closure. This team works closely with internal and external partners to deliver key strategic projects, manage applications, and improve Client Services processes. You will actively participate on client calls. You will define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders and seek approval. To be successful you will bring your developed skills as an innovative, analytical, energetic, problem solver. You will be seen as a client problem-solver and will bring innovation solution for client requirements. If this describes you, then become part of our “go-to team”. As a Test Analyst, you will own following responsibilities: Understanding Client needs and Client requirements, translate into Test Scenarios to validate Benefit Configuration and Benefits Coding. Building relationships with key client partners through a consultative approach to fully understand benefit components of client benefit plan design needs Translating Client needs and requirements to internal CVS Health team such as Benefits Coding and Quality Analysis team. Providing timely communications to provide status updates and make decisions relative to client benefit set up. Coordinate with your colleagues and take ownership of the test artifacts and client reviews Support other test analysts by providing training, coaching, and counseling and providing in depth quality reviews of what you learn Expertise on EZTEST Usage(myPBM), Sales force, EZQUERY, EXCEL Macros, Formulary management system and NDC LookUp Tool. Translate CMS, Client defined Requirements, business rules, and validate before code promotion to production. Facilitating internal and external meetings and presentations to provide status updates and ensure Benefit configuration accuracy for Client’s requirement Define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders to ensure highest quality to meet or exceed turnaround time and project timelines. Develop process improvement initiatives in support of department efficiency. Pinpoint areas of opportunity and training needs. Work through the various phases of the project until all issues have been resolved, cleanup complete and all reportable items are closed to the satisfaction. Escalate project risks and concerns to test management and other project stakeholders Share the daily or weekly test status with management Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround Your success will be driven by exceeding client satisfaction score targets as well as working towards reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Claims Adjudication will also contribute to your success. You will operate in a dynamic environment with tight deadlines so ability to operate. The contributions you will make as a Test Analyst, Client benefits will position CVS Health as a leader in Client Satisfaction and service in the Pharmacy Benefit Management Marketplace.

Requirements

• 2+ years of Healthcare/PBM experience or 4+ years of IT experience.

Nice To Haves

• Excellent communication (Verbal and Written) and collaboration skills
• Demonstrated ability to manage and organize projects from start to completion
• Computer proficiency in MS Office applications (Microsoft Word; Microsoft Excel, Microsoft PowerPoint, and Microsoft Outlook).
• Ability to work independently with little supervision
• Ability to work and communicate effectively with multiple departments and individuals.
• PBM/Claim Adjudication knowledge is mandatory
• Plan Benefits, Formulary and Utilization Management knowledge is a plus.
• EZQUERY/Sequel hands-on Claim processing tool (EZTEST), Sales force.
• Medicaid / Medicare requirement knowledge

Responsibilities

• Understanding Client needs and Client requirements, translate into Test Scenarios to validate Benefit Configuration and Benefits Coding.
• Building relationships with key client partners through a consultative approach to fully understand benefit components of client benefit plan design needs
• Translating Client needs and requirements to internal CVS Health team such as Benefits Coding and Quality Analysis team.
• Providing timely communications to provide status updates and make decisions relative to client benefit set up.
• Coordinate with your colleagues and take ownership of the test artifacts and client reviews
• Support other test analysts by providing training, coaching, and counseling and providing in depth quality reviews of what you learn
• Expertise on EZTEST Usage(myPBM), Sales force, EZQUERY, EXCEL Macros, Formulary management system and NDC LookUp Tool.
• Translate CMS, Client defined Requirements, business rules, and validate before code promotion to production.
• Facilitating internal and external meetings and presentations to provide status updates and ensure Benefit configuration accuracy for Client’s requirement
• Define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders to ensure highest quality to meet or exceed turnaround time and project timelines.
• Develop process improvement initiatives in support of department efficiency.
• Pinpoint areas of opportunity and training needs.
• Work through the various phases of the project until all issues have been resolved, cleanup complete and all reportable items are closed to the satisfaction.
• Escalate project risks and concerns to test management and other project stakeholders
• Share the daily or weekly test status with management
• Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level