CVS Health
Plan Coordination Consultant
CVS Health, Atlanta, Georgia, United States, 30383
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary
Manages and coordinates medical, pharmacy and wellness benefit installation for new and existing customers. Processes and coordinates all plan benefit changes, required structural and administrative updates into systems essential for on-line viewing, claim, enrollment and billing purposes.Completes timely and accurate coding of complex account structure and detailed benefit plans in systems for multiple constituents to satisfy both internal and external deadlines for production – impacting a wide variety products and services.Reviews benefit provisions to ensure compliance with state and Federal legislative mandates; evaluation process may also include assessment of summary plan descriptions and other related documents prepared by the plan sponsor or third party.Applies certain medical guidelines HCR (Healthcare Reform), IRS standards, types of eligibility and ability to identify discrepancies. Ensures installation documents are complete and accurate for delivery of a successful implementation with an eye toward downstream impact.Uses all applicable systems and tools available to ensure accurate and timely installation.Influence changes or enhancements to business processes, policies, tools and system functionality to improve quality and drive benefit accuracy and supportability thereby reducing medical and operating cost (e.g. rework).Required Qualifications
Overtime opportunity exists in 4th Quarter (October 1st- December 31st), PTO (Paid Time Off) limitations will be in place.1+ Year Experience working for an insurance provider or healthcare company, and/or administrative experience in a Medical FacilityHigh attention to detail and accuracyLogic and analytical skills including problem solvingAbility to manage multiple priorities, research and work within several applications simultaneouslyStrong typing, computer navigation and organizational skillsExcellent verbal and written communication skillsFoundational experience in ExcelStrong team player with a desire for collaboration across departmentsBenefit and product knowledgeExcellent customer service skillsPreferred Qualifications
Functional product knowledge of medical, pharmacy and wellness benefitsMinimum of 2 years of health insurance experience, successful customer service or claim processing experience; preferably Senior level.Experience with and application of State and Federal healthcare legislation.Intermediate to advanced experience in Excel.Mentoring experience.Education
High School Diploma or equivalentPay Range
The typical pay range for this role is: $17.00 - $28.45. 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.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit
jobs.CVSHealth.com/benefits .We anticipate the application window for this opening will close on: 03/17/2024.CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through
ColleagueRelations@CVSHealth.com . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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Manages and coordinates medical, pharmacy and wellness benefit installation for new and existing customers. Processes and coordinates all plan benefit changes, required structural and administrative updates into systems essential for on-line viewing, claim, enrollment and billing purposes.Completes timely and accurate coding of complex account structure and detailed benefit plans in systems for multiple constituents to satisfy both internal and external deadlines for production – impacting a wide variety products and services.Reviews benefit provisions to ensure compliance with state and Federal legislative mandates; evaluation process may also include assessment of summary plan descriptions and other related documents prepared by the plan sponsor or third party.Applies certain medical guidelines HCR (Healthcare Reform), IRS standards, types of eligibility and ability to identify discrepancies. Ensures installation documents are complete and accurate for delivery of a successful implementation with an eye toward downstream impact.Uses all applicable systems and tools available to ensure accurate and timely installation.Influence changes or enhancements to business processes, policies, tools and system functionality to improve quality and drive benefit accuracy and supportability thereby reducing medical and operating cost (e.g. rework).Required Qualifications
Overtime opportunity exists in 4th Quarter (October 1st- December 31st), PTO (Paid Time Off) limitations will be in place.1+ Year Experience working for an insurance provider or healthcare company, and/or administrative experience in a Medical FacilityHigh attention to detail and accuracyLogic and analytical skills including problem solvingAbility to manage multiple priorities, research and work within several applications simultaneouslyStrong typing, computer navigation and organizational skillsExcellent verbal and written communication skillsFoundational experience in ExcelStrong team player with a desire for collaboration across departmentsBenefit and product knowledgeExcellent customer service skillsPreferred Qualifications
Functional product knowledge of medical, pharmacy and wellness benefitsMinimum of 2 years of health insurance experience, successful customer service or claim processing experience; preferably Senior level.Experience with and application of State and Federal healthcare legislation.Intermediate to advanced experience in Excel.Mentoring experience.Education
High School Diploma or equivalentPay Range
The typical pay range for this role is: $17.00 - $28.45. 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.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit
jobs.CVSHealth.com/benefits .We anticipate the application window for this opening will close on: 03/17/2024.CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through
ColleagueRelations@CVSHealth.com . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
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