Dual Entry Plan Builder

CVS Health

1d

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 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.

Requirements

• 1-2 years Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)
• This person should be highly organized and able to quickly prioritize multiple assignments with high quality results.
• This person should have good communication skills with the ability to express complex concepts in a clear and concise manner.
• This person should have a high attention to detail and accuracy while focusing on overall project deliverables.
• This person should have the ability to remain flexible yet focused during stressful situations.
• This person should possess good analytical and problem solving skills.

Nice To Haves

• 5 years healthcare industry experience with benefits
• Bachelors Degree preferred or High School diploma/GED and equivalent work experience

Responsibilities

• 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.
• 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.

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: Entry Level
• Education Level: High school or GED