Senior Plan Builder, CVS Health

CVS Health

Location:
United States

Category:
-

Contract Type:
Not provided

Salary:

46988.00 - 112200.00 USD / Year

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Provide plan benefit review, interpretation, and systematic setup essential to the processing of our claims adjudication system
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

Requirements:

1+ year experience working with healthcare and prior plan build experience
1+ year Prior Plan build experience
1+ year experience working with escalations, research, multitasking (will be working on more than one client at a time), and mentoring/training
Be highly organized and able to quickly prioritize multiple assignments with high quality results

Nice to have:

5+ years’ experience working with healthcare
Good 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
Good analytical and problem-solving skills
Ability to research and look beyond the first right answer to find the root of a concern

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
July 31, 2025

Expiration:
September 06, 2025

Employment Type:

Fulltime

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Senior Plan Builder