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About the Role
Provides plan benefit review, interpretation, and systematic setup for online viewing and processing, supporting customer service, claims, enrollment, billing, and reporting for internal and external partners. Utilizes proprietary systems for analytical coding of customized plans and develops implementation strategies consistent with client expectations.
Responsibilities
- Utilize Meritain’s proprietary system for analytical coding of detailed customized plans.
- Develop and execute implementation strategy consistent with client expectations.
- Ensure strategy is administered in accordance with all performance guarantee arrangements.
- Consult and advise internal stakeholders on complex benefit administration.
- Advise on options to minimize manual processing and disruption for clients.
- Use business knowledge and experience to make plan design and processing recommendations.
- Review benefit provisions to ensure compliance with state and federal mandates.
- Evaluate summary plan descriptions and other related documents.
- Collaborate on review, analysis, and development of recommendations for complex account and benefit structures.
- Execute system setup and mapping of client level benefits to align with industry coding.
- Solicit and assess internal and external customer feedback to drive continuous quality improvement.
- Demonstrate Salesforce proficiency and understanding for cross-functional communication.
- Enable executive-level status reporting.
Requirements
- 2+ years of experience working with healthcare, specifically with quality, renewals, client advocacy, and/or account management.
- Demonstrated knowledge of medical terminology.
- Ability to work Monday-Friday from 8am-5pm.
- Ability to work beyond core hours during busy seasons.
Skills
- Salesforce proficiency
- Analytical coding
- Benefit administration
- Medical terminology
- System setup
- Client advocacy
- Account management
- Problem-solving skills
- Communication skills
- Organization skills
- Attention to detail
Location
- Remote
Work Type
- Full time
Experience Level
- 2+ years
- 5+ years
Education Level
- Associate’s or Bachelor’s degree
- High school diploma or GED
Salary/Compensations
- $46,988.00 - $102,000.00
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
About the Company
- We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.
- At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
- Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
- 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.
Equal Opportunity
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.