Remote job at CVS Health [Manager, Client Benefits] 2024
FULL-TIME
FULL-STACK PROGRAMMING
ANYWHERE IN WORLDWIDE
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Company- CVS Health
Position – Manager, Client Benefits
Location– Remote
Salary- The pay Range is $60,300 to $132,600 annually+ Benefits and Perks
More about CVS Health
CVS Health is a leading American healthcare company dedicated to improving the health and wellness of individuals nationwide. Established in 1963, CVS Health has grown from a retail pharmacy chain into a diversified health solutions provider, encompassing pharmacy services, health insurance, and retail health clinics. With thousands of locations and a strong digital presence, CVS Health offers a comprehensive range of services, including prescription management, affordable care at MinuteClinic and HealthHUB locations, and insurance options through Aetna, which CVS acquired in 2018. The company is deeply committed to creating accessible healthcare options, focusing on preventative care, chronic disease management, and affordable treatment solutions to meet the needs of millions of Americans. CVS Health is vital in helping individuals lead healthier lives, backed by innovative technology, integrated healthcare solutions, and an expansive network of care providers through its various health services.
Description
At CVS Health, we are united by a shared purpose: to bring genuine care and dedication to every aspect of your health journey. This mission guides us in creating healthcare solutions that are compassionate and centered on the needs of each individual. Our brand is rooted in the idea that how we deliver our services is just as crucial as the services themselves. Through our “Heart At Work Behaviors™,” we empower every team member to contribute to a culture of innovation, helping us make healthcare more personalized, accessible, and affordable for all. By focusing on empathy and commitment, CVS Health strives to transform healthcare in a rapidly evolving world.
Preferred Qualifications
- Strong verbal and written communication skills, with a proven ability to collaborate effectively.
- Skilled in organizing and managing projects from inception to completion.
- Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook.
- Experienced in claim adjudication processes.
- In-depth understanding of Pharmacy Benefit Management (PBM) and healthcare industry practices.
- Knowledgeable in formulary management and utilization management (required).
- Hands-on experience with EZQUERY and SQL tools.
- Skilled in creating and defining test conditions for benefit assessments.
- Capable of training, coaching, and mentoring team members in benefit testing procedures.
- Familiar with claim processing tools (e.g., EZTEST) and Salesforce platform.
- Knowledge of Medicaid-specific benefit programs by state.
Also Apply For
Required Qualifications
- 5+ years of Healthcare/PBM experience
- Bachelor’s degree: Equivalent experience can also be considered
Position Summary
As a Benefit Testing Manager, you will join the Client Benefit Services QA team, collaborating with functions such as Clinical and Benefit Organization. Your primary focus will be on problem-solving, improving processes, and enhancing automation within the testing team. This role allows you to apply your technical knowledge of Pharmacy Benefit Management (PBM) and analytical skills to assess business processes, integrate technology, and improve the efficiency of benefit testing operations. You will be responsible for analyzing Medicaid state-specific benefit programs to ensure compliance, translating them into business rules, and developing test strategies and scripts for validation.
You will lead daily activities for critical benefit testing initiatives, providing business rules for automation tools and identifying areas for process improvement. As part of this role, you will collaborate closely with internal and external stakeholders to execute strategic projects, manage applications, and enhance Client Services processes. Participation in client calls is an essential component, where you will define benefit test requirements, create test plans, execute scenarios, document results, and present findings to stakeholders for approval.
To thrive in this position, you should bring a blend of innovation, analytical thinking, and problem-solving abilities. As a member of our “go-to team,” you will define the benefit test strategy, train testing staff, and drive enterprise-level testing initiatives to ensure accuracy and quality in benefits administration. You will also serve as a subject matter expert to elevate benefit quality, enhance client satisfaction, and act as the primary contact to maintain high standards across Medicare, Medicaid, Commercial, and Exchange lines of business.
Work Responsibilities
- Take full ownership and act as a subject matter expert in testing client benefit plan designs, specifically within Utilization Management and Formulary, and present test results to internal benefits teams and external clients.
- Understand client needs and benefit requirements, translating them into test scenarios to validate benefit configuration and coding accuracy.
- Demonstrate expertise in tools such as EZTEST (claim processing tool), Salesforce, EZQUERY, Excel Macros, formulary management systems, and Benefit Serve/Benefit Builder.
- Interpret CMS and state-mandated benefit programs and rules, defining and validating business rules before code promotion to production.
- Facilitate internal and client meetings and presentations, providing status updates to ensure benefit configuration accuracy is aligned with client requirements.
- Build consultative relationships with key client partners to fully understand the components of their benefit plan design needs.
- Define benefit test requirements, develop test plans, execute test scenarios, and capture and present test results to all stakeholders.
- Assess project risks and create risk mitigation plans; provide weekly status updates to leadership and other stakeholders.
- Develop and implement process improvement initiatives to support departmental efficiency, identifying areas for improvement and training needs.
- Advise colleagues on setup and testing for various client benefit plan designs within the benefits space.
- Manage the project through all phases until all issues are resolved, cleanup is complete, and all reportable items are closed to satisfaction.
- Identify benefit testing gaps across Commercial, Medicaid, Medicare, and Exchange lines of business.
- Create benefit test strategies to address identified testing gaps.
- Propose and develop automation tools to improve testing accuracy and speed.
Your success will be measured by surpassing client satisfaction score targets and minimizing production defect leakage for clients. Your expertise in the healthcare industry, particularly in areas such as Formulary Management, Drug Utilization Management, and Claims Adjudication, will be key to achieving these goals. You will work in a dynamic environment with tight deadlines, requiring you to effectively manage and deliver results. As a Test Subject Matter Expert (SME), the contributions you make will position CVS Health as a leader in client satisfaction and service within the Pharmacy Benefit Management (PBM) marketplace.
Salary Range
The typical pay range for this role is $60,300 to $132,600 annually. This range reflects the base hourly rate or base annual full-time salary for positions within this job grade. The actual salary offered will depend on various factors, including experience, education, location, and other relevant considerations. This position may also be eligible for additional compensation, such as bonuses, commissions, or short-term incentives, on top of the base pay.
In addition to competitive compensation, CVS Health offers a comprehensive benefits package. Employees have access to medical, dental, and vision insurance, and may participate in a 401(k) retirement savings plan and an Employee Stock Purchase Plan if eligible. CVS Health provides fully-paid term life insurance and both short-term and long-term disability benefits for qualifying employees. Additional perks include well-being programs, educational assistance, professional development courses, and discounts at CVS stores and with select partners. For time off, CVS Health employees receive Paid Time Off (PTO) or vacation days, along with paid holidays throughout the year. The number of paid holidays, sick days, and other leave is provided according to state laws and company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
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