Dual Entry Plan Builder

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

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.

• 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.
• Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements.
• Uses critical thinking and extensive knowledge of Meritain's system and processes to evaluate impact of client requested exceptions and develops reasonable alternatives to satisfy client's needs while minimizing impact on Meritain's 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 Meritain's system.
• Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans rather than standard offerings.
• Effectively manages implementation and provides direction to fellow team members ensuring success of overall implementation process. Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.
• Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)
• Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting.
• Reviews coverage files at intervals throughout the first year of implementation to analyze for setup adjustments to align with claim processing reports to achieve higher levels of auto adjudication opportunities.

Required Qualifications

• 1 year healthcare industry experience with benefits interpretation

Preferred Qualifications

• Customer Service, Claims, and or Plan Build preferred
• Salesforce experience preferred
• Detail oriented
• Highly organized
• Good communication skills

Education

• High School Diploma or GED

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

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  Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
  
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  No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
  
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  Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
  

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/17/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.