Plan Sponsor Service Consultant

CVS Health
US - West Virginia - Charleston
November 17, 2024

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

This position will primarily support the Enrollment Data Validation Audit (EDV), Retroactive Processing Contractor (RPC) and Strategic Recon functions.
The EDV Audit is completed on a monthly basis and is a review of a monthly sample of enrollment related transactions submitted to CMS.
The team is responsible to provide the RPC with supporting documentation for the transactions selected.
The RPC process works to get members updated within the MARx systems by submitting Category 2 or 3 appeals.
Strategic Recon is the reconciliation between the internal Market Prominence and HRP systems.
This position will be required to collaborate within our teams and other departments such as enrollment and CTM/Grievance.
This position will require the individual to learn multiple functions including strategic reconciliation and Retroactive Processing Contractor.
Must have the ability to provide process improvement opportunities to the management team and be a team player.
Strong verbal and written communication skills and the ability to work independently will be important to success in this role.

Required Qualifications

1-3 years of Medicare knowledge background.
Minimum of 1 year of experience in a production based environment.

Preferred Qualifications

Knowledge of the MAPD/Aetna systems (Market Prominence) as well as the SSI/PDP systems (PDP systems is a plus)
Ability to prioritize tasks/work effectively.
Strong organization skills.
Problem solving skills.
Attention to detail and accuracy.
Proficient in Microsoft Word, PowerPoint, Excel, Outlook and Teams

Education

High School Diploma or equivalent

Pay Range

The typical pay range for this role is:

$17.00 - $34.15

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 Benefits | CVS Health (***/us/en/benefits)

We anticipate the application window for this opening will close on: 11/16/2024

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Read the full job description and apply online on the recuiter's web-site

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