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CVS Health Claim Reporting, Services Specialist in Lansing, Michigan

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

This role is for Meritain Health PBM Operations Team and is responsible for collaborating with Implementation Managers, Pharmacy Implementation Managers, various external PBM vendors, and clients to implement the following files to be used for invoice processing and member accumulators: eligibility, accumulators, invoices, and claims detail.

Job Duties

  1. New group and renewal group implementations are completed by meeting with the PBM vendors and groups for requirements. (20%)

  2. New group and renewal group implementations are set-up in the system based on selected PBM vendor with data elements, field mapping, naming conventions, file feed locations, platform, and back-end vendor. (30%)

  3. Coordinate and conduct IT related activities such as ticket submissions and testing. (20%)

  4. New group and renewal group implementations tasks are notated with completion date in Salesforce with every step. (10%)

  5. New group and renewal group implementations post-implementations tasks are completed, file receipts confirmed, and hand-off sheet routed to Invoice Processor Team. (10%)

  6. Escalations are supported with a sense of urgency, communication to stakeholders throughout, and worked until 100% resolved. (10%)

Required Qualifications

Intermediate to Advanced Excel Experience

Minimum 2 years PBM or other Healthcare experiencePreferred Qualifications Technical experience preferred Education

Associates degree preferred, but not required

Pay Range

The typical pay range for this role is:

$18.50 - $35.29

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 05/13/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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