Grievance Analyst (Caseworker)

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

CVS Health has an exciting new opportunity within the Grievances team in Scottsdale, AZ. As a Grievance Analyst, you will be responsible for researching, resolving, and communicating any issues, questions, or concerns our members have about their coverage and benefits provided through Medicare Part D.
You will have the opportunity to work cross functionally with different departments within CVS Health to support the research into these members’ issues. Once resolved you will be responsible for outreach to each member with a verbal and/or written response explaining the resolution of the issues.
As you support our Med D members, we will support you by offering all the tools and resources you need in a collaborative team-based environment. Our goal is to ensure you can provide top tier service and resolution for our members. We use our own emphasis on quality as well as government mandated turnaround times to ensure we do our job effectively, always focusing on helping people on their path to better health.
In order to be successful in this role you will need to be detail-oriented with proficient research skills and demonstrate the ability to analyze data, apply learnings, and construct a resolution in a timely manner. A successful Analyst is receptive to constructive feedback and flexible in adapting to change while effective in planning, prioritizing, and organizing their time and workload to achieve production goals and turnaround time requirements. Analysts are expected to close grievances cases daily, close 15-20 cases per week (depending on inventory) and close all cases within 25 days of TAT while maintaining the highest quality standards. In this position you will be measured by your ability to use your judgement to execute to reach these department goals.
Additional responsibilities of the Analyst include creatively constructing written formal communication to members, multitasking, and working with up to 15 various computer applications and documenting the issue and resolutions in the database, while adhering to the strict turnaround times established by the Center for Medicare and Medicaid Services (CMS).

REQUIRED QUALIFICATIONS

• 2 plus years of experience working within a customer service role on several computer applications and complex databases for research, including Microsoft Office products (Excel, Word, and Outlook).

PREFERRED QUALIFICATIONS

• Previous experience within Pharmacy Benefit Management (PBM) or pharmaceutical related industry.
• Previous Med D grievance experience.
• Bachelors Degree Preferred.

EDUCATION

High School Diploma or equivalent General Education Degree (GED)

Please refer the Job description for details