Dual Entry Plan Builder
Dual Entry Plan Builder
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$ 43888 - 93574
1 Vacancy
Job Description
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven 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
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.
- Reviews benefit provisions to ensure compliance with state and federal 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 Meritains system and processes to evaluate impact of client requested exceptions and develops reasonable alternatives to satisfy clients needs while minimizing impact on Meritains 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 Meritains system.
- Ability to utilize Meritains 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.
Required Qualifications
- 1 year healthcare industry experience with benefits interpretation
Preferred Qualifications
- Customer Service Claims and or Plan Build preferred
- Salesforce experience preferred
- Detail oriented
- Highly organized
- Good communication skills
Education
- High School Diploma or GED
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$43888.00 $93574.00This pay range represents the base hourly rate or base annual fulltime salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or shortterm incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages our great benefits include:
Affordable medical plan options a 401(k) plan (including matching company contributions) and an employee stock purchase plan.
Nocost 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.
For more information visit anticipate the application window for this opening will close on: 04/17/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.
Employment Type
Full-Time
