Job Description
Job Description
As a Client Benefits Advisor, you will be seen as a problem-solver and will bring innovative solutions for a high-profile client. You will work closely with client and operations partners to consult on and document benefit requirements, configuration and testing considerations. You will bring with you experience in the PBM industry and deep knowledge of benefit structure and CVS systems, which will allow you to work closely with our clients on complex and challenging benefits to ensure that client intent is met, that the benefit can be properly maintained, and that the requirements are properly recorded so that other business partners (coders, testers and QA staff) can effectively and efficiently use the documentation for their work. You will also take the lead to develop new benefit capabilities, triage critical and complex issues, maintain critical policies, procedures abd work instructions, implement benefit process improvements, and participate in requirements calls with benefits and operations partners.
Some of your additional responsibilities will include:
- Providing consultative and strategic solutions to complex new and existing client benefit designs, enterprise product initiatives and regulatory requirements for the clients business.
- Collaborate with key staff to review and interpret changes and determine how they would impact the current benefit set-up.
- Nurture the adoption of technology and automation solutions to improve quality, efficiency and execution of benefit implementation.
- Consult, document and secure approval of benefit designs and requirements.
- Validate configured benefits align with the client requirements and participate in test result walkthroughs to drive higher levels of quality and client satisfaction.
- Resolve benefit issues on a timely basis
- Complete Root Cause Analysis (RCA) and Corrective Action Plans (CAPS) for internal and external distribution.
- Lead special projects related to client requests, IT and Compliance/Regulatory initiatives.
- Maintain policies and procedures/work instructions.
Your success will be driven by exceeding client satisfaction score targets as well as working towards reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, Reimbursement and Claims Adjudication will also contribute to your success.
In this role, you will operate in a fast-paced environment with tight deadlines so your ability to operate autonomously and make key decisions is imperative. The contributions you will make as a Client Benefits Advisor will position CVS Health as a leader in client satisfaction and service in the Pharmacy Benefit Management marketplace.
Required Qualifications
- 3 or more years of client facing experience
- 3 or more years of experience managing benefit requirements for PBM implementations or Employer/Health Plan accounts
- Deep understanding of benefits: Accumations, Copay/Coinsurance, Utilization Management, Formulary and Prior Authorization with demonstrable ability to interface and coach on that understanding with key partners.
- Expert level experience in RxClaim
Preferred Qualifications
- Benefits coding operations experience
- Demonstrate solid understanding of client urgency and attentiveness to timeline requirements
- Able to work in dynamic and changing work environment with quick turn-around.
- Ability to exercise solid professional judgement in analyzing business issues and exploring resolution options.
- Strong decision-making and creative problem solving skills.
- Excellent verbal and written communication skills, including experience with presentations
- Ability to gain closure on issues and work assignments.
- Ability to be decisive in ambiguous situations.
- Excellent interpersonal and time management skills.
- Proven track record of building, managing and maintaining business relationships with external and internal partners.
Education
- Bachelors degree strongly preferred
- Verifiable High School Diploma or GED 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 Client Benefits Advisor, you will be seen as a problem-solver and will bring innovative solutions for a high-profile client. You will work closely with client and operations partners to consult on and document benefit requirements, configuration and testing considerations. You will bring with you experience in the PBM industry and deep knowledge of benefit structure and CVS systems, which will allow you to work closely with our clients on complex and challenging benefits to ensure that client intent is met, that the benefit can be properly maintained, and that the requirements are properly recorded so that other business partners (coders, testers and QA staff) can effectively and efficiently use the documentation for their work. You will also take the lead to develop new benefit capabilities, triage critical and complex issues, maintain critical policies, procedures abd work instructions, implement benefit process improvements, and participate in requirements calls with benefits and operations partners.
Some of your additional responsibilities will include:
- Providing consultative and strategic solutions to complex new and existing client benefit designs, enterprise product initiatives and regulatory requirements for the clients business.
- Collaborate with key staff to review and interpret changes and determine how they would impact the current benefit set-up.
- Nurture the adoption of technology and automation solutions to improve quality, efficiency and execution of benefit implementation.
- Consult, document and secure approval of benefit designs and requirements.
- Validate configured benefits align with the client requirements and participate in test result walkthroughs to drive higher levels of quality and client satisfaction.
- Resolve benefit issues on a timely basis
- Complete Root Cause Analysis (RCA) and Corrective Action Plans (CAPS) for internal and external distribution.
- Lead special projects related to client requests, IT and Compliance/Regulatory initiatives.
- Maintain policies and procedures/work instructions.
Your success will be driven by exceeding client satisfaction score targets as well as working towards reduced service warranty payments to clients. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, Reimbursement and Claims Adjudication will also contribute to your success.
In this role, you will operate in a fast-paced environment with tight deadlines so your ability to operate autonomously and make key decisions is imperative. The contributions you will make as a Client Benefits Advisor will position CVS Health as a leader in client satisfaction and service in the Pharmacy Benefit Management marketplace.
Required Qualifications
- 3 or more years of client facing experience
- 3 or more years of experience managing benefit requirements for PBM implementations or Employer/Health Plan accounts
- Deep understanding of benefits: Accumations, Copay/Coinsurance, Utilization Management, Formulary and Prior Authorization with demonstrable ability to interface and coach on that understanding with key partners.
- Expert level experience in RxClaim
Preferred Qualifications
- Benefits coding operations experience
- Demonstrate solid understanding of client urgency and attentiveness to timeline requirements
- Able to work in dynamic and changing work environment with quick turn-around.
- Ability to exercise solid professional judgement in analyzing business issues and exploring resolution options.
- Strong decision-making and creative problem solving skills.
- Excellent verbal and written communication skills, including experience with presentations
- Ability to gain closure on issues and work assignments.
- Ability to be decisive in ambiguous situations.
- Excellent interpersonal and time management skills.
- Proven track record of building, managing and maintaining business relationships with external and internal partners.
Education
- Bachelors degree strongly preferred
- Verifiable High School Diploma or GED 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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