Job Description The Client Benefit Rep III will analyze client benefit requests, determine best operational approach and perform coding. This employee will also validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. The Client Benefit Rep II will be responsible for meeting or exceeding turnaround time and quality standards as well as researching client benefit requests/issues and recommending alternative solutions to internal partners in meeting client needs. In addition to coding, this position will also be responsible performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines. This position may support coding, testing and QA activities for commercial clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.)
Required Qualifications - 2 + years of experience within a Healthcare or Pharmacy environment - 2+ years of experience with AS400/RxClaim - 2+ years of experience with the Microsoft Office Suite
Preferred Qualifications - Previous coding experience - Ownership and results driven - Customer focused - Attention to detail - Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality - Ability to effectively work within a team - Flexible in adapting to change - Demonstrated ability to analyze data and determine conclusions - Ability to learn and apply increasingly complex concepts, policies and procedures - Ability to effectively plan, prioritize, organize time and workload - Skilled in identifying and solving issues and recommending process improvements - Ability to work successfully in a deadline-oriented environment - Project Management skills - Well organized with the ability to effectively prioritize work - Excellent verbal and written communication skills
Education High School Diploma or GED required Bachelor's degree preferred
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.
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