Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

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 mandates.  Evaluation 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 Meritain’s system and processes to evaluate impact of client requested exceptions and develops reasonable alternatives to satisfy client’s needs while minimizing impact on Meritain’s 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 Meritain’s system.
• Ability to utilize Meritain’s 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 (i.e. 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

• 3-5 years of healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)

Preferred Qualifications

• Attention to detail and Identifying items to correct.
• Highly organized
• Good communication skills

Education

• High School Diploma or GED.                         

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.80

This pay range represents the base hourly rate or base annual full-time 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 short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/03/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.