Associate Plan Builder (Meritain Health)

at  CVS Health

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

The Associate Plan Builders will provide plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. Meritain’s proprietary system provides a benefit solution for customized benefit plans. Plan Builders must be able to research and follow through on escalations and urgent requests. They must possess an analytical system coding ability to translate plan benefits into system data coding. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.

• Provides plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.
• Ability to utilize Meritain’s proprietary system for analytical coding of detailed customized plans rather than standard offerings.
• Participate and engage in discussion with Clients related to benefit interpretation. Advising on State and Federal Mandates as well as system capabilities.
• Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.
• Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients.
• 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.
• Uses business knowledge and experience to make plan design and processing recommendations when working with Clients.
• Evaluates 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.
• Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.
• 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.

REQUIRED QUALIFICATIONS

• Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)
• Experienced with various data systems (DOS systems a plus)
• Medical Terminology
• Be highly organized and able to quickly prioritize multiple assignments with high quality results.
• Must have strong communication skills with the ability to express complex concepts in a clear and concise manner.
• High attention to detail and accuracy while focusing on overall project deliverables.
• Ability to remain flexible yet focused during stressful situations.
• Analytical and problem solving skills.

PREFERRED QUALIFICATIONS

• 5+ years’ experience working with Healthcare.
• Salesforce
• Ability to research and look beyond the first right answer to find the root of a concern

EDUCATION

• 
  Highschool Diploma or GED.

Please refer the Job description for details