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.

Oversees the day-to-day management and leadership of critical aspects of the Medicare Prescription Payment Plan (M3P) opt-in/out data reconciliation operations. Develops a team to manage the transmission and receipt of opt-in/out data from members and clients, identifies and remediates file transmission and receipt issues, develop and maintain workflow instructions, ensure CMS and client compliance items are met, and ensure consistent high quality customer service occurs within the department.

What you will do

• Oversees and manages the eligibility process for healthcare coverage by ensuring accurate and timely determination of eligibility status for individuals seeking coverage.
• Develops and implements policies and procedures to ensure compliance with eligibility requirements.
• Analyzes and reviews eligibility applications, documentation, and supporting information to determine eligibility status.
• Communicates clear explanations of eligibility criteria, requirements, and any necessary follow-up actions and addresses inquiries regarding eligibility status and benefits coverage.
• Monitors key performance indicators (KPIs) related to eligibility, such as eligibility turnaround time, application accuracy, and customer satisfaction.
• Collaborates with internal departments and external partners, such as insurance providers and government agencies, to verify eligibility information and resolve eligibility-related issues.
• Delivers training programs for the eligibility team to ensure their understanding of eligibility criteria, documentation requirements, and relevant regulations.
• Interviews, hires, and develops talent, provides guidance and coaching, and fosters a high-performance culture.
• Oversees ongoing training to ensure all team members are fully versed and compliant within their respective roles.

For this role you will need Minimum Requirements

• 7-10 years work experience
• Experience with submitting, tracking, and resolving IT tickets.
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at collaboration and teamwork
• Mastery of problem solving and decision making skills
• Mastery of growth mindset (agility and developing yourself and others) skills

Preferred Qualifications

• 3-5 years Medicare Part D experience
• Experience with secure File Transfer Protocols (sFTP) file exchanges.
• Experience with Splunk application, including building dashboards, reports, and queries.
• RxClaim (AS400)

Education

• Bachelor's degree preferred/specialized training/relevant professional qualification.

Pay Range

The typical pay range for this role is:

$82,940.00 - $182,549.40

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.  This position also includes an award target in the company’s equity award program. 
 
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: 10/28/2024

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