Senior Renewal Plan Build

CVS Health•Plymouth, ID

1d•$46,988 - $122,400•Hybrid

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 Places a high priority on teamwork, looking beyond the first right answer when assisting others and performing group research. Contributes to the success of the team and individual team members by sharing knowledge, information, experience, skill, and creative ideas within and across teams; build relationships, give and seek input from others, cross-trains to other departments, ability to assist others in complex builds, quality reports and projects to achieve goals. Is an un-official leader on the team, aware that actions, attitude, and communications reflect upon not only self but the team as well. Solicits and assesses internal and external customer feedback to drive continuous quality improvement on the renewal process (ie. System tools, resources, etc.). 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. Advanced ability to utilize Meritain’s proprietary system for analytical coding of detailed customized plans rather than standard offerings. Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements. Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients. 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. Uses business knowledge and experience to make plan design and processing recommendations when working with Clients. 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. Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.

Requirements

Minimum 1 year experience in Meritain Plan Build.
1+ years experienced with various data systems (DOS systems a plus).
1+ years medical terminology knowledge.

Nice To Haves

3+ years’ experience working with healthcare (Quality, Claims, and or Plan Build preferred).
Ability to research and look beyond the first right answer to find the root of a concern.
Be highly organized and able to quickly prioritize multiple assignments with high quality results.
Must have strong communication skills with the ability to express complex concepts in a clear and concise manner.
High attention to detail and accuracy while focusing on overall project deliverables.
Ability to remain flexible yet focused during stressful situations.
Analytical and problem-solving skills.

Responsibilities

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.
Advanced ability to utilize Meritain’s proprietary system for analytical coding of detailed customized plans rather than standard offerings.
Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements.
Consult and advise internal stakeholders on complex benefit administration.
Advising on options to minimize manual processing and disruption for the Clients.
Reviews benefit provisions to ensure compliance with state and federal mandates.
Uses business knowledge and experience to make plan design and processing recommendations when working with Clients.
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.
Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.