Job Description
As the Benefits Setup Representative III you will be responsible for supporting internal partners aligned to the Benefits Consultation Center (BCC). The BCC collaborates with Account Management, Implementation Management as well as our Benefits Employer Client Services Team (CST) to capture client intent for new plan implementations as well as changes to existing plans.
Intent must be captured in a manner that is understandable to both our clients, internal partners and our Benefits organization.
Interaction with clients is likely, mostly by phone but in some occasions face to face.
You will provide analytical expertise to support the Client Benefits department related to Employer clients' benefit plans. Your ability to work flexibly within a team and adapt to change will assist you in supporting our internal teams of benefit coders, testers and QA by providing in-depth reviews and distributing information relevant to Employer plan setups. Additionally, you will provide subject matter expertise and oversight of issues, identify solutions to resolve issues and identify process improvement opportunities to make the process of plan design requests more efficient.
You will be responsible for meeting or exceeding turnaround time and quality standards as well as researching client benefit requests/issues and recommending alternative solutions to internal partners in meeting client needs.
Required Qualifications
- 2 + years of experience within a Healthcare or Pharmacy environment
- 2+ years of experience with AS400/RxClaim
- 2+ years of experience with the Microsoft Office Suite
Preferred Qualifications
- Previous coding experience
- Ownership and results driven
- Customer focused
- Attention to detail
- Able to meet aggressive turnaround time standards/client
performance guarantees coupled with excellent quality
- Ability to effectively work within a team
- Flexible in adapting to change
- Demonstrated ability to analyze data and determine
conclusions
- Ability to learn and apply increasingly complex concepts, policies and procedures
- Ability to effectively plan, prioritize, organize time and
workload
- Skilled in identifying and solving issues and recommending process improvements
- Ability to work successfully in a deadline-oriented
environment
- Project Management skills
- Well organized with the ability to effectively prioritize
work
- Excellent verbal and written communication skills
Education
High School Diploma or GED required
Bachelor's degree preferred
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Hartford, CT
Aetna Inc. operates as a health care benefits company in the United States. It operates through three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment offers medical, pharmacy benefit management service, dental, behavioral health, and vision plans on an insured and employer-funded basis. It also provides point-of-service, preferred provider organization, health maintenance organization, and indemnity benefit plans, as well as health savings accounts and consumer-directed health plans.
In addition, this segment offers Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers’ compensation administrative services, and products that provide access to its provider networks in select geographies. The Group Insurance segment offers life insurance products, including group term life insurance, voluntary spouse and dependent term life insurance, group universal life insurance, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which provide the benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities.
The Large Case Pensions segment manages various retirement products comprising pension and annuity products primarily for tax-qualified pension plans. The company provides its products and services to employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is based in Hartford, Connecticut. As of November 28, 2018, Aetna Inc. operates as a subsidiary of CVS Pharmacy, Inc.