CVS Health

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Benefits Setup Representative III

at CVS Health

Posted: 4/22/2019
Job Reference #: 944940BR

Job Description

Job Title :
Benefits Setup Representative III
Job ID :
Location :
IL - Northbrook|TX - Irving|RI - Lincoln
Street Address :
2215 Sanders Road Suite 500
Category :
Customer Service
Description :
Job Description
As a Benefits Quality Analysis Rep III, you will be part of an extremely talented team within our Client Benefits Quality department at CVS Health. You will be responsible for analyzing client requests and performing the necessary benefits testing and quality assurance. You’ll work alongside other Benefits Coders, Testers, and Quality Assurance Representatives, as well as our Account Management and Implementation teams to deliver high quality support to our vast number of clients. Extreme attention to detail is important for this role, as your testing and quality assurance activities will impact not only the commercial clients at CVS Health, but the federal and state programs that we participate in, such as Medicare Part D and Medicaid.

This is a fantastic opportunity to start your career in the Pharmacy Benefit Management (PBM) industry, as extensive training will be provided.

3+ years of professional work experience in Claims, Insurance, QA, Testing, or a high-production environment.

Required Qualifications
3+ years of related work experience required data analysis, auditing, information systems, computer engineering or other related background
- Previous work experience in a PBM, Medical Claims, Health Insurance, Pharmacy, or Benefits.
-Advanced Microsoft Excel skills for data analysis; proficient in using other Microsoft Office applications

Preferred Qualifications
* Strong mathematical skills
* Technical aptitude, comfortable working in database systems
* Provide leadership and identify opportunities to improve efficiency/quality
* Able to deliver per the timelines
* Effectively participate in RCA’s and apply the 5-Why process
* Work large / complex clients to ensure 100% test coverage and review for proper set-up that meets client intent
* Mentor and coach other team members
* Project Management skills
* Responsible for maintaining your (SFDC) queue at all times
* Regression Testing, Query Testing and AS400 experience preferred
* 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 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'
* Able 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
* Demonstrated ability to make decisions independently by applying sound judgment based on business principals and supporting data facts
* Demonstrated ability to be accountable and independent. Results driven and performs at a high level with minimal supervision
* Self-motivated and detail oriented focused on ensuring client intent is met and minimizing financial exposure
* Able to apply logical thinking and analytical skills to: research claims issues, formulate a strategic approach to efficiently build plans by performing analysis, and then execute and validate the plan build
* Able to seek out and find solutions independently
* Able to prioritize issues and operate in environment of regulatory compliance and audit
* Well organized and able to effectively prioritize work
* High level of attention to detail
* Excellent verbal and written communication skills
* Able to meet aggressive turnaround time standards and client performance guarantees coupled with excellent quality
* Able to effectively work within a team
Flexible in adapting to change
* Able to learn and apply increasingly complex concepts, policies and procedures
* Able to effectively plan, prioritize, organize time and workload; in an environment of cyclical volume

High School Diploma or GED required.
Bachelor's degree is 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.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!