What are the responsibilities and job description for the Benefits Setup Representative II position at CVS Health?
Job Description
As the Benefits Setup Representative II you will provide analytical expertise to support the Client Benefits department related to Employer clients. Your flexible ability to work flexibly within a team and adapt to change will assist you in supporting the team of benefit coders, testers and QA through mentoring, providing in-depth quality reviews and distributing information relevant to Employer plan setups. Additionally, you will provide SME oversight of operational issues, identify solutions to resolve process issues and operational gaps, and identify process improvement opportunities to make the process of plan design requests more efficient. You will also organize, prioritize and support urgent issues including but not limited to research and analysis of benefit setup issues, employer tracking issues and global quality checks for insurance, QA, Testing, or a high-production environment.
Our ideal candidate will be self-motivated and detail-oriented with a focus on ensuring client intent is met and minimizing financial exposure. Your excellent analytical, verbal and written communication skills should allow you to thrive and be successful in a fast-paced, operational environment that is very client-centric; where there is high variability between clients’ plan designs. Additionally, you will have demonstrated the ability to make decisions independently with accountability and minimal supervision by applying sound judgment based on business principals and supporting data facts. As the Benefits Setup Representative II you will be able to apply logical thinking and analytical skills to research claims issues, formulate a strategic approach to efficiently build plans by performing analysis, and execute and validate the plan build, you should also have experience in seeking out and finding solutions independently while prioritizing issues and operating in environment of regulatory compliance and audit.
As the Benefits Setup Representative II your responsibilities will include:
-Analyzing client benefit requests, determining the best operational approach and perform coding.
-Performing testing and QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines.
-Validating coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction.
-Meeting or exceeding turnaround time and quality standards.
-Researching client benefit requests/issues and recommending alternative solutions to internal partners in meeting client needs.
-Providing consultation and benefits expertise to internal partners.
Required Qualifications
-3+ years of related work experience required.
Related work experience may include data analysis, auditing, information systems, computer engineering or other related backgrounds
-1+ years of experience working in database systems
-3+ years of data analysis experience using Microsoft Excel skills for data analysis;
-1+ years of experience using other Microsoft Office applications
-1+ years of experience meeting aggressive turnaround time standards and client performance guarantees coupled with excellent quality
Preferred Qualifications
-Prior healthcare experience in medical or pharmacy: Managed care experience such as PBM, health insurance or healthcare claims processing is a plus; or Pharmacy technician or retail/ mail/ hospital pharmacy experience
-Experience in a quality assurance and/or testing, that includes analyzing financial and/or plan design accuracy according to benefit plan rules and financial agreements
-Experience in AS400/RxClaim system
-Experience using and building automation tools such as macros, queries and SQL
-Experience with data mining large data-sets and critically analyzing for trends and accuracy
-Auditing experience
-Able to serve in indirect leadership role and effectively communicate with leadership team
-Possess skills to identify and solve issues by recommending process improvements
-Possess Project Management skills
-Possess thorough understanding of Caremark site platform/system applications/products
-Proficient in analyzing and executing clinical and non-clinical client work requests
-Good understanding of Sarbanes Oxley practices
-Experience with manipulating large data sets for loading drug level information using industry standard drug identifiers.
-Experience in a B to B environment and client vendor relationships
-Knowledge of Employer clients and/or Medicare and Medicaid
Education
Verifiable High School Diploma or GED
Business Overview
It’s a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.
As the Benefits Setup Representative II you will provide analytical expertise to support the Client Benefits department related to Employer clients. Your flexible ability to work flexibly within a team and adapt to change will assist you in supporting the team of benefit coders, testers and QA through mentoring, providing in-depth quality reviews and distributing information relevant to Employer plan setups. Additionally, you will provide SME oversight of operational issues, identify solutions to resolve process issues and operational gaps, and identify process improvement opportunities to make the process of plan design requests more efficient. You will also organize, prioritize and support urgent issues including but not limited to research and analysis of benefit setup issues, employer tracking issues and global quality checks for insurance, QA, Testing, or a high-production environment.
Our ideal candidate will be self-motivated and detail-oriented with a focus on ensuring client intent is met and minimizing financial exposure. Your excellent analytical, verbal and written communication skills should allow you to thrive and be successful in a fast-paced, operational environment that is very client-centric; where there is high variability between clients’ plan designs. Additionally, you will have demonstrated the ability to make decisions independently with accountability and minimal supervision by applying sound judgment based on business principals and supporting data facts. As the Benefits Setup Representative II you will be able to apply logical thinking and analytical skills to research claims issues, formulate a strategic approach to efficiently build plans by performing analysis, and execute and validate the plan build, you should also have experience in seeking out and finding solutions independently while prioritizing issues and operating in environment of regulatory compliance and audit.
As the Benefits Setup Representative II your responsibilities will include:
-Analyzing client benefit requests, determining the best operational approach and perform coding.
-Performing testing and QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines.
-Validating coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction.
-Meeting or exceeding turnaround time and quality standards.
-Researching client benefit requests/issues and recommending alternative solutions to internal partners in meeting client needs.
-Providing consultation and benefits expertise to internal partners.
Required Qualifications
-3+ years of related work experience required.
Related work experience may include data analysis, auditing, information systems, computer engineering or other related backgrounds
-1+ years of experience working in database systems
-3+ years of data analysis experience using Microsoft Excel skills for data analysis;
-1+ years of experience using other Microsoft Office applications
-1+ years of experience meeting aggressive turnaround time standards and client performance guarantees coupled with excellent quality
Preferred Qualifications
-Prior healthcare experience in medical or pharmacy: Managed care experience such as PBM, health insurance or healthcare claims processing is a plus; or Pharmacy technician or retail/ mail/ hospital pharmacy experience
-Experience in a quality assurance and/or testing, that includes analyzing financial and/or plan design accuracy according to benefit plan rules and financial agreements
-Experience in AS400/RxClaim system
-Experience using and building automation tools such as macros, queries and SQL
-Experience with data mining large data-sets and critically analyzing for trends and accuracy
-Auditing experience
-Able to serve in indirect leadership role and effectively communicate with leadership team
-Possess skills to identify and solve issues by recommending process improvements
-Possess Project Management skills
-Possess thorough understanding of Caremark site platform/system applications/products
-Proficient in analyzing and executing clinical and non-clinical client work requests
-Good understanding of Sarbanes Oxley practices
-Experience with manipulating large data sets for loading drug level information using industry standard drug identifiers.
-Experience in a B to B environment and client vendor relationships
-Knowledge of Employer clients and/or Medicare and Medicaid
Education
Verifiable High School Diploma or GED
Business Overview
It’s a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.
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