Client Benefit Representative II

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

As a Client Benefit Representative II you will be responsible for analyzing client requests and performing the necessary benefits coding and quality assurance activities. You’ll work alongside team responsible for coding, testing, and performing quality assurance, as well as our implementation Management team to deliver high quality support to our clients. Extreme attention to details is important for this role, as your coding and quality assurance activities will impact commercial clients at CVS Health. You will be expected to execute with high level of accuracy, responsiveness, and reliability while performing job functions


What you will do

·         Configures benefits programs within the healthcare company's systems or databases.

·        Follow policies and best practices relating to the job function by analyzing client requests, determine the best operational approach and install adjudication related drug lists (eg formulary, clinical edits, plan coverage, etc) in Salesforce and Rxclaim/AS400

·         Processes member or subscriber enrollments into the benefits programs by entering enrollment data, verifying eligibility based on plan requirements, and ensuring accurate and timely enrollment for individuals or groups.

·     Able to meet all turnaround time and performance guarantees with excellent quality
·         Ability to collaborate regularly with peers to audit, review and verify drug list coding and testing while utilizing various tools

·         Ensures the accuracy and integrity of data related to benefits program setup by reviewing and validating data entries, performing data audits, and making corrections or updates as needed to maintain accurate and up-to-date information.

·         Organizes documentation and records of benefits program setup activities, including plan configurations, enrollment data, eligibility determinations, and any modifications or updates made.

·         Assists in providing regular, timely feedback to ensure delivery of exceptional services and engagement, motivation, and team development.

Communicates with various internal teams, such as benefits administration, HR, or IT, to gather and exchange information related to benefits setup and enrollment

Requirements

• 2-3 years of direct work experience with PBM knowledge
• Proficient use Microsoft Office applications, e.g. Excel, Word
• Experience with AS400 / RxCLAIM
• Working knowledge of SalesForce.com

Preferred Qualifications

• Certified Pharmacy Technician

• Well organized with the ability to prioritize work

  effectively and independently

• Flexible in adapting to change

• Excellent time management skills

• Excellent interpersonal and collaborative skills with the ability to work in a team environment

• Ability to work successfully in a deadline-oriented environment

• Excellent verbal and written communication skills

• Strong analytical skills and attention to detail. Ability to define problem, review data, establish facts, and draw valid conclusions

Education

·         High School Diploma

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $31.30

This pay range represents the