CVS Health

Remote/Telecommute

Plan Builder

Posted over 1 month ago

Job Description

Job Description
Provides plan benefit review, interpretation and systematic setup essential for online viewing and processing related to Customer Service, Claims, Enrollment, Billing and Reporting in support of internal and external partners.
Fundamental Components
* 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 pricing recommendations when working with prospective customers.
* Evaluates impact of client requested exceptions and develops reasonable alternatives to satisfy clients needs while minimizing impact on Meritains 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 Meritains system.
* Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.)
* Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)

Required Qualifications
* Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)
* Detail oriented
* Highly organized
* Good communication skills

Preferred Qualifications
Claims experience
Experience with medical plan documents

Education
BA or equivalent work experience

Business Overview
At Aetna, a CVS Health company, 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 are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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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