Job Description
As the Senior Analyst, Client Benefits, you will champion the strategic documentation, coding, and deployment of our client's prescription benefit plan designs. You will be seen as a client problem-solver and will bring innovation solutions for high-profile clients. You will be responsible for analyzing client requests, case management, recommending design, performing coding and root cause analysis. You will also validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. You will be responsible for meeting or exceeding the turnaround time and quality standards as well as researching client benefit requests/issues and recommending alternative solutions to internal partners in meeting client needs. The outcomes you drive will have a direct impact to client satisfaction score targets and financial commitments within the client contracts. Your current and continued investment of knowledge in the areas of Benefits Coding, Formulary Management, Drug Utilization Management, and Reimbursement and Claims Adjudication will be critical to your success . You will operate in fast-paced environment with tight deadlines that requires high levels of individual accountability and good decision making.
Some of these responsibilities include, but not limited to:
- Building relationships with key client partners through a -
consultative approach to understand client benefit plan
design needs
- Translating client needs and requirements to internal
CVS Health teams such as Benefits Coding and Quality
Analysis
- Providing timely communications to provide status
updates and make decisions relative to client benefit
setup
- Case management/design uniformity: Responsible for
leading requirement intake and setting proper case
parameters
- Case triage: Responsible for triage of each case to the
appropriate team/individual
Install adjudication related (e.g. formulary, clinical edits,
plan coverage, etc.) in Salesforce and Rxclaim/AS400
- Create & monitor reports in relation to team inventory
and productivity within Salesforce.com
-Root cause analysis documentation: Responsible for
leading team discussions and documenting root cause
and preventative measures as a result of these
discussions
- Research client claim inquiries: Responsible for initial
triage and route cause analysis for potential claim
concerns
- Identify Process Improvement opportunities
-Collaborate regularly with peers to audit, review and
verify drug list coding and testing while utilizing various
tools
Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 100,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Required
• 5 or more years of experience in benefit plan design/coding/testing/account management, or related field
• Proficient use Microsoft Office applications, e.g. Excel, Word
• 2 years’ experience understanding of RxClaim platform/system applications/products
• 2 years’ experience with Salesforce.com
• Strong analytical skills and attention to detail.
• Excellent verbal and written communication skills
• Willingness and Ability to Travel up to 30% for client support if needed
Preferred
• Certified Pharmacy Technician
• Well organized with the ability to prioritize work effectively and independently
• Flexible in adapting to change
• Excellent time management skills
• Excellent interpersonal and collaborative skills with the ability to work in a team environment
• Ability to work successfully in a deadline-oriented environment with excellent quality
• Ability to define problem, review data, establish facts, and draw valid conclusions
• Flexible in adapting to change
• Experience in analyzing and executing clinical and/or non-clinical work requests
• Ability to learn and apply increasingly complex concepts, policies and procedures
• Proficient in EzQuery and proficient in querying RxClaim to satisfy data requests from the client.
• Expert level experience in RX Claim
• Experience with Benefit Builder and FMS
• PBM Industry experience
• Benefits Coding Operations experience
Preferred Qualifications
2 years of Salesforce experience preferred
Education
• Bachelor’s degree preferred but not required, equivalent
work experience may be considered.
Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.