Implementation Specialist (Meritain Health)

CVS Health

1d•$46,988 - $122,400

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The Implementation Specialist manages and coordinates benefit plan implementation for new and existing customers. This person provides focused service, fostering strong relationships with internal business partners, in order to assure all group implementation and administrative updates are loaded correctly. Job duties include: Analyzing and determining if products and services selected by clients are aligned and can be adequately supported by existing systems or operating platforms; additionally, seeking solutions and negotiating essential requirements in support of any non-standard plan selections. Requires dynamic decision making to appropriately structure the group setups within the Meritain system to align with our vendor partners (Pharmacy Benefit Managers, Managed Care Entities, etc.) and analytics vendors, and provide the required structure for client billing and reporting. Actively consulting and communicating with internal staff regarding the details associated with new business and revision activity in a timely manner, as well as validating account structure. Completing timely and accurate set-up of complex account structure and detailed benefit plans in systems (for multiple constituents), in order to satisfy both internal and external deadlines for production, impacting a wide variety of products and services. Monitoring and managing internal installation process, as well as maintaining case tracking to meet constituents’ expectations and business goals. Maintaining data files for monthly group reporting, assuring PHI (Personal Health Information) guidelines are being followed. Running monthly reports for all clients and brokers. Responding to escalated issues related to group setup. Assisting with the development and testing of new or enhanced group setups. Providing technical expertise to team/unit, mentoring junior staff members, and assisting with the development and implementation of training tools and processes. Running adhoc data programs to assist with streamlining setup of group and eligibility files. Running adhoc data programs to quickly audit setup of customized group enrollments. Partnering in projects with our Products and IT teams to add/enhance products and services. Serving as the point person for testing of all changes related to the ER/EO/GIM data files. Performing other duties as needed.

Requirements

1+ year of experience in health care
High school diploma or GED

Nice To Haves

3+ years of experience in health care
Previous experience in medical group implementation
Previous experience working with medical data files
Detail-oriented
Strong analytical skills
Excellent multi-tasking ability
Associate’s degree or higher

Responsibilities

Analyzing and determining if products and services selected by clients are aligned and can be adequately supported by existing systems or operating platforms
Seeking solutions and negotiating essential requirements in support of any non-standard plan selections
Structuring the group setups within the Meritain system to align with our vendor partners (Pharmacy Benefit Managers, Managed Care Entities, etc.) and analytics vendors, and provide the required structure for client billing and reporting
Actively consulting and communicating with internal staff regarding the details associated with new business and revision activity in a timely manner, as well as validating account structure
Completing timely and accurate set-up of complex account structure and detailed benefit plans in systems (for multiple constituents), in order to satisfy both internal and external deadlines for production, impacting a wide variety of products and services
Monitoring and managing internal installation process, as well as maintaining case tracking to meet constituents’ expectations and business goals
Maintaining data files for monthly group reporting, assuring PHI (Personal Health Information) guidelines are being followed
Running monthly reports for all clients and brokers
Responding to escalated issues related to group setup
Assisting with the development and testing of new or enhanced group setups
Providing technical expertise to team/unit, mentoring junior staff members, and assisting with the development and implementation of training tools and processes
Running adhoc data programs to assist with streamlining setup of group and eligibility files
Running adhoc data programs to quickly audit setup of customized group enrollments
Partnering in projects with our Products and IT teams to add/enhance products and services
Serving as the point person for testing of all changes related to the ER/EO/GIM data files
Performing other duties as needed

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.

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