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Benefit Setup Representative
at CVS Health
The employee will analyze client benefit requests, determine best operational approach and perform coding. This employee will also validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. The employee will be responsible for meeting or exceeding turnaround time and quality standards as well as researching client benefit requests/issues and recommending 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 Strategic Health Plan clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.)
-2+ years of related work experience.
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
-Verifiable High School diploma or GED is required.
-Bachelor's degree or equivalent experience required.
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.