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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

The Associate Plan Builders will provide plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. Meritain’s proprietary system provides a benefit solution for customized benefit plans. Plan Builders must be able to research and follow through on escalations and urgent requests. They must possess an analytical system coding ability to translate plan benefits into system data coding. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.

• Provides plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.

• Ability to utilize Meritain’s proprietary system for analytical coding of detailed customized plans rather than standard offerings.

• Participate and engage in discussion with Clients related to benefit interpretation. Advising on State and Federal Mandates as well as system capabilities.

• Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.

• Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients.

• 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.

• Uses business knowledge and experience to make plan design and processing recommendations when working with Clients.

• Evaluates 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.

• Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.

• 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.

Required Qualifications

• Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)

• Experienced with various data systems (DOS systems a plus)

• Medical Terminology

• Be highly organized and able to quickly prioritize multiple assignments with high quality results.

• Must have strong communication skills with the ability to express complex concepts in a clear and concise manner.

• High attention to detail and accuracy while focusing on overall project deliverables.

• Ability to remain flexible yet focused during stressful situations.

• Analytical and problem solving skills.

Preferred Qualifications

• 5+ years’ experience working with Healthcare.

• Salesforce

• Ability to research and look beyond the first right answer to find the root of a concern

Education

• Highschool 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: 12/16/2024

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