Job DescriptionThe Client Benefit Rep III will analyze client benefit requests, determine best operational approach to ensure the highest quality standards and perform testing quality activities for 100% claim adjudication outcome against client intent.
This employee will also validate coding accuracy utilizing various tools to ensure no financial impact and or client-participant dissatisfaction. The Client Benefit Rep III will be responsible for meeting or exceeding turnaround time and quality standards as well as researching client benefit requests for testing quality issues. In addition, the Client Benefit Rep III will recommend alternative solutions to internal partners and or leaders in meeting client needs.
Additional responsibilities include:
- Able to lead any client; acts as a Subject Matter expert for at least one LOB.
- Work on large/complex client projects by defining a Test-QA Strategy.
- Consulting with both BRMs, SMEs and implementing benefit testing-QA to meet client intent.
- Provide thought leadership for process improvement.
- Effectively leads insightful root cause analysis exercises.
- Review and seek approvals for Test deliverables with Client.
- Timely Salesforce.com updates.
- Deliver per the timelines and contractual performance guarantee.
- Mentor and coach others towards positive meaningful outcomes that encompass our core values. 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- Self-starter with solid planning skills
- Proactive ownership and results driven
- Customer focused
- Attention to detail
- Able to meet aggressive
turnaround time standards/client performance guarantees coupled with excellent testing quality.
- Ability to effectively work within a team
- Flexible in adapting to change
- Demonstrated ability to analyze data and determine solid timely conclusions
- Ability to learn and apply increasingly complex concepts, policies and procedures
- Ability to effectively plan, prioritize, organize time management 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
Bachelors Degree Preferred Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, 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
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health
CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.
For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/