Manager - Client Benefits

CVS Health•Irving, TX

1d•$60,300 - $132,600•Onsite

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. As a Benefit Testing Manager, you will be part of Client Benefit Services QA team that is engaged across multiple functions including Clinical and Benefit Organization, with particular emphasis on solving problems, process improvement and increase automation opportunity within testing team. You will have the opportunity to utilize your PBM technical 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 Medicaid state compliance Benefit programs and translate those into business rule and define test strategy and scripts to validate the same. You will independently work on leading day to day activities of key Benefit testing initiatives and provide business rules for Automation tools. You will also play a vital role in finding opportunities for improvements and problem-solving issues encountered by the team. 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. If this describes you, then become part of our “go-to team”. You will define Benefit Test Strategy, Train testing resources, Define and Drive Enterprise level Test Initiative to ensure Benefit accuracy, Provide Subject Matter Expertise to enhance Benefit Quality and Client Satisfaction, and act as a single point of contact to reduce PGs on Quality within Medicare, Medicaid, Commercial and Exchange line of business. As a Benefit Testing Manager/ Subject Matter Expert (SME), you will own following responsibilities: Take full ownership and serve as subject matter expert for testing all client’s benefit plan designs in the Benefit space of Utilization Management and Formulary, and present Test Results to Internal Benefits team and External Clients. Understanding client needs and Benefit requirements, translate into Test Scenarios to validate Benefit Configuration and Benefits Coding. Expertise on EZTEST (claim processing tool), Sales force, EZQYERY, EXCEL Macro, Formulary management system and Benefit Serve/Benefit builder. Translate CMS and state mandate Benefit program/rule and define business rule 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. Building relationships with key client partners through a consultative approach to fully understand Benefit components of client benefit plan design needs. Define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders. Assess project risks and provide risk mitigation plans, weekly statuses with leadership and other stakeholders. Develop process improvement initiatives in support of department efficiency. Pinpoint areas of opportunity and training needs. Advise colleagues in performing set ups and testing for various benefit plan designs in Benefit space of client requirements. 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. Identify Benefit testing gap for Commercial, Medicaid, Medicare, and Exchange Line of Business Create Benefit Test Strategy for identified Benefit testing gap areas. 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 driving Production defect leakage for 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 SME will position CVS Health as a leader in client satisfaction and service in the PBM marketplace.

Requirements

6+ years of Healthcare/PBM Experience
Claim Adjudication Knowledge
Complete Knowledge and Understanding on Benefits and Clinical Configuration Setup
Expertise on EzQuery/Sequel and Eztest
Ability to train resources with Clinical Testing Process
Bachelor’s degree and Equivalent experience can also be considered
Operate in a dynamic environment with tight deadlines

Nice To Haves

PBM technical skills
logical skills
analytical skill
innovative, analytical, energetic, problem solver
Healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Claims Adjudication

Responsibilities

Define Benefit Test Strategy
Train testing resources
Define and Drive Enterprise level Test Initiative to ensure Benefit accuracy
Provide Subject Matter Expertise to enhance Benefit Quality and Client Satisfaction
Act as a single point of contact to reduce PGs on Quality within Medicare, Medicaid, Commercial and Exchange line of business
Take full ownership and serve as subject matter expert for testing all client’s benefit plan designs in the Benefit space of Utilization Management and Formulary, and present Test Results to Internal Benefits team and External Clients
Understanding client needs and Benefit requirements, translate into Test Scenarios to validate Benefit Configuration and Benefits Coding
Translate CMS and state mandate Benefit program/rule and define business rule 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
Building relationships with key client partners through a consultative approach to fully understand Benefit components of client benefit plan design needs
Define Benefit test requirements, create test plans, and execute test scenarios, capture test results, present test results to all stakeholders
Assess project risks and provide risk mitigation plans, weekly statuses with leadership and other stakeholders
Develop process improvement initiatives in support of department efficiency
Pinpoint areas of opportunity and training needs
Advise colleagues in performing set ups and testing for various benefit plan designs in Benefit space of client requirements
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
Identify Benefit testing gap for Commercial, Medicaid, Medicare, and Exchange Line of Business
Create Benefit Test Strategy for identified Benefit testing gap areas
Propose/develop testing automation tools to enhance testing accuracy and rapid turnaround