Job Description As the Clinical Operations Advisor for Specialty Adjudication you will consult with our clients to capture their specialty plan design requirements. You will also champion any conversations necessary between internal groups to clarify any questions about client intent. You will be an authority on specialty benefit adjudication, and will need to bring innovative solutions for enhancements to the system for pharmacy benefit management (PBM)clients. You will accomplish this by:
- Building Relationships with key client partners through a consultative approach to understand client plan design needs
- Translating client needs and requirements to internal CVS Health teams such as SpecialtyAdjudication coding
- Facilitating Internal and external meetings to provide status updates and make decisions
Your success will be determined by your ability to track all new clients undergoing implementation and actively request documentation if it has not been received. You will also need to work with a consultative approach to negotiate solutions to specialty benefit design limitations within tight deadlines, and act as a liaison between underwriting and implementations. You may have the opportunity to mentor and train new employees within the department as necessary and perform as the lead for implementing larger,complex client’s specialty benefits. As you succeed in this role you will have an impact on our client satisfaction and help to grow CVS Health's standing themarketplace.
Required Qualifications * 5 or more years of experience benefit plan design, data analysis or a related field
* 3+ years of RxClaim experience
* Minimal Travel may be required
Preferred Qualifications * SalesForce proficiency
* Ability to effectively work within a team
* Demonstrable ability to analyze data and determine conclusions and provide solutions
* Ability to learn and apply increasingly complex concepts, policies and procedures
* Proven advanced level usage of the Microsoft Office Suite, to include Excel and Access
* Skilled in identifying and solving issues and recommending process improvements
* Ability to work successfully in a dynamic, client focused environment
* Experience with Formulary, Utilization Management and Medicare Part D
Education * Bachelor’s Degree is required
* Equivalent combination of education and experience may be considered
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/