Job Description
Job Description
As a Senior Advisor level Benefit Relationship Manager you will interface as the Benefits & Clinical lead on new business implementations, critical initiatives and maintenance of business benefits requirements. You will collaborate with Clients, Consultants, Account Management, Implementations to build client requirement for new plan & clinical implementations as well as changes to existing clients and plans.
Daily responsibilities include articulating, communicating and capturing requirements that are accurate and understandable to both our clients, internal partners and our Benefits & Clinical organization while considering and solving for downstream impacts or risk. In addition to building accurate requirements, you will be responsible for evaluating capabilities of the adjudication platform and validation that the system can adequately and accurately support and adjudicate claims per client requirements. You will have responsibility for determining timelines and making commitments on behalf of the organization and delivery to milestones and approved client requirements, as well as providing status to leadership.
Additionally, responsibilities can include the review and research of potential client issues, and providing recommendations to leadership if a potential error would invoke a Service Warranty or Performance Guarantee payout.
To be a successful team member you will be solution oriented, innovative, and collaborative to develop risk mitigation strategies based on issues presented. Additionally, possess strong communication and time management skills.
Primary Duties:
* Defining and Documenting Requirements with Clients, Implementation and Account Managers
* Consulting with clients on proposed solutions to meet objectives & goals including financial & member experience
* Research, Analyzing impacts for consideration of requirements or errors and providing direction on adjudication setups & solution to Configuration & Quality for mitigation
* Cross functional project support to improve benefits requirements process
* Mentorship of colleagues with Benefit & Clinical Ops
**This is a work from home role and can be located anywhere in the US.
Required Qualifications
* 7 or more years of leading benefit projects, including 2 years of benefit coding knowledge in AS400/RxClaim
* Medicare experience
Preferred Qualifications
* Excellent knowledge of RxClaim across multiple lines of business (Commercial, Medicare, & Medicaid &Exchanges)
* Possesses excellent verbal and written communication skills
* Advanced knowledge of Microsoft Office applications including Work, Excel, Powerpoint, Access; project management, Visio a plus
* Ability to define problem, collect data, establish facts, and draw valid conclusions/results
* Ability to be decisive in ambiguous situations to resolve issues, and meet assignment deliverables
* Demonstrate leadership competencies on assignments, projects and improvements
* Strong leadership skills with ability to coach, manage, mentor, develop and guide employee performance and team level
Education
* Bachelors Degree is required
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
As a Senior Advisor level Benefit Relationship Manager you will interface as the Benefits & Clinical lead on new business implementations, critical initiatives and maintenance of business benefits requirements. You will collaborate with Clients, Consultants, Account Management, Implementations to build client requirement for new plan & clinical implementations as well as changes to existing clients and plans.
Daily responsibilities include articulating, communicating and capturing requirements that are accurate and understandable to both our clients, internal partners and our Benefits & Clinical organization while considering and solving for downstream impacts or risk. In addition to building accurate requirements, you will be responsible for evaluating capabilities of the adjudication platform and validation that the system can adequately and accurately support and adjudicate claims per client requirements. You will have responsibility for determining timelines and making commitments on behalf of the organization and delivery to milestones and approved client requirements, as well as providing status to leadership.
Additionally, responsibilities can include the review and research of potential client issues, and providing recommendations to leadership if a potential error would invoke a Service Warranty or Performance Guarantee payout.
To be a successful team member you will be solution oriented, innovative, and collaborative to develop risk mitigation strategies based on issues presented. Additionally, possess strong communication and time management skills.
Primary Duties:
* Defining and Documenting Requirements with Clients, Implementation and Account Managers
* Consulting with clients on proposed solutions to meet objectives & goals including financial & member experience
* Research, Analyzing impacts for consideration of requirements or errors and providing direction on adjudication setups & solution to Configuration & Quality for mitigation
* Cross functional project support to improve benefits requirements process
* Mentorship of colleagues with Benefit & Clinical Ops
**This is a work from home role and can be located anywhere in the US.
Required Qualifications
* 7 or more years of leading benefit projects, including 2 years of benefit coding knowledge in AS400/RxClaim
* Medicare experience
Preferred Qualifications
* Excellent knowledge of RxClaim across multiple lines of business (Commercial, Medicare, & Medicaid &Exchanges)
* Possesses excellent verbal and written communication skills
* Advanced knowledge of Microsoft Office applications including Work, Excel, Powerpoint, Access; project management, Visio a plus
* Ability to define problem, collect data, establish facts, and draw valid conclusions/results
* Ability to be decisive in ambiguous situations to resolve issues, and meet assignment deliverables
* Demonstrate leadership competencies on assignments, projects and improvements
* Strong leadership skills with ability to coach, manage, mentor, develop and guide employee performance and team level
Education
* Bachelors Degree is required
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited 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.
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