Job Description In this role, you will analyze client benefit requests, determine best operational approach, and perform coding. You will validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. In addition, this position is responsible for meeting or exceeding turnaround time and quality standards. You will be researching client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs.
In addition to coding, this position will also be responsible performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines. This position may support coding and QA activities for commercial clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.)
Required Qualifications - 2+ years of professional work experience in Claims, Insurance, QA, Testing, or a high-production environment
Preferred Qualifications - Previous work experience in a PBM, Medical Claims, Health Insurance, Pharmacy, or Benefits highly preferred.
- Well organized with the ability to effectively prioritize work
- Ownership and results driven
- Customer focused
- Attention to detail
- Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality
- Proficient use Microsoft Office applications, e.g. Excel, Word
- Ability to effectively work within a team
- Flexible in adapting to change
- Demonstrated ability to analyze data and determine conclusions
- Ability to learn and apply increasingly complex concepts, policies and procedures
- Ability to effectively plan, prioritize, organize time and workload
- Skilled in identifying and solving issues and recommending process improvements
- Ability to work successfully in a deadline-oriented environment
- Excellent verbal and written communication skills
- Project Management skills EducationHigh School Diploma/GED required
Bachelor's degree preferred
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW
and EEO IS THE LAW SUPPLEMENT
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health
CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/