The Client Benefit Representative II will analyze client benefit requests, determine best operational approach and perform coding. This employee will also validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. The Client Benefit Representative II 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.
In addition to coding, this position will also be responsible performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines. This position may support coding, testing and QA activities for commercial clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.)
We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays.
- 2 + years experience within a Healthcare, Pharmacy Benefit Management or Pharmacy environment
- 2+ years experience with AS400/RXclaim
Previous coding experience
Bachelor's degree in any discipline is preferred
High School Diploma or GED required
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.
Apply on company website