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.

As a Clinical Client Operations Advisor, you will use a combination of your operational and analytical knowledge to assist the account team and client by providing oversight and systems expertise. You will ensure the client intent is applied and tested for clinical changes. You will play a lead role in supporting the implementation and system configuration of client specific clinical and government programs. Additionally you will translate marketplace and client information into the adjudication system. You will have the opportunity to utilize operational and analytical skills in a managed care environment to positively impact the health of consumers while helping reduce health care costs. You will also perform activities in support of work within the department.  You will accomplish this by:  

• Analyzing complex data, identifying root causes and assisting with driving practical and creative solutions.
• Recommend operational improvements both strategically and in the day-to-day application of organizational policies and procedures.
• Participate in a culture of collaboration and accountability.       
• Foster teamwork and a supportive departmental culture with an emphasis on ensuring exceptional client service.
• Identify and implement departmental best practices.
• Develop documented processes and procedures as needed to create and maintain effective and productive workflows.
• Act as liaison with other departments in collaborative approach for workflow issues.

Your success will be driven by the team in their goals for exceeding client satisfaction score targets as well as contributing to reduced service warranty payments to clients. Your healthcare industry familiarity, clinical knowledge, analytical, and process improvement skills will also contribute to your success. You will need to be effective in analyzing and executing stakeholder/business partner work requests and quality audits as well. You will operate in a fast-paced environment with tight deadlines so ability to operate autonomously and make key decisions is imperative. The contributions you will make will position CVS Health as a leader in client satisfaction and service in the PBM marketplace. 

Required Qualifications

• 5+ years in a PBM or Managed Care setting
• 1+ year using MS Word, Excel, and Outlook, with experience creating and updating Excel spreadsheets
• Advanced understanding of Utilization Managment and Formulary set-up
• Knowledge of the Pharmacy Benefit Management and/or Health Insurance Industry from a operations perspective

Preferred Qualifications

• RXclaim experience preferrably Rxclaim Coding and RxClaim Query/EZ Query experience
• SalesForce.com
• Strong interpersonal skills
• Strong analytical skills
• Working knowledge of word processing, spreadsheet, work flow management applications.  
• Demonstrate a clear understanding of company and client confidentiality.   
• Adaptable and able to move with change while maintaining a positive attitude and strong role model for the Team      

Education

• Bachelors degree preferred or equivalent experience in PBM

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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: 01/12/2025

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