These positions are for Senior Product configuration resources. Scope of responsibility includes:
- Provides support for analysis, configuration, testing and implementation of product and benefit plans initiatives.
-This includes support for Medicare business expansions, for both Individual Advantage, DSNP, VBID and Group product offerings that will be implemented on the NextGen Strategic platform, Health Rules Payor.
- Successful candidates will have a mix of product and benefits knowledge and use in claims adjudication processing.
- If your goal is to combine your strong healthcare product/benefit knowledge, with a bent for analytic and technical implementation, then this is the ideal job for you.
- You will determine the best approach for driving the desired benefit outcomes in claims processing and provider payment.
- This is a unique opportunity to be on a dynamic Team that is shaping the new delivery of healthcare.
- Communicates product features and fundamental components to key stakeholders in Product Strategy, Network, Medical Policy and Claims operational areas respectively.
- Two or more years previous experience configuring benefit plan components, values lists and service categories on the Health Rules Payor application and use in claims processing.
- Three plus years experience with coding standards, ICD 10, CPT and HCPC codes.
- Strong analytic skills to determine requirements and considerations for configuring benefit plans, with an eye to reuse.
- Prior experience with interpreting and evaluating CMS and state legislation on benefit plans.
- Demonstrated prior results as project manager in determine requirements, testing, and implementing initiatives for small/medium initiatives.
- Ability to handle multiple priorities, and deliver on time and with quality limiting re-work.
- Strong communication skills, comfortable presenting options for configuration to several levels of management.
- Advanced Excel skills.
- Three or more years experience with product development.
- Three of more years in complex claims payment processing and production support.
- Experience with SQL or other query languages.
- Prior experience working in and Agile organization.
- Bachelor's degree in business management or healthcare.
At Aetna, a CVS Health company, 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 are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.
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