Eligible to Apply Anywhere in the US
Provides production support for Medicare product and benefit and automation initiatives supporting increased AA and increased efficiency for updates to product and benefits and production plan moves.
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 Medicare product/benefits knowledge, with your analytic and technical implementation skills, 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. Experience with coding standards, ICD 10 and CPT codes would be beneficial. You will also need to evaluate the impact of CMS and state legislation on benefit plans. This is a unique opportunity to be on a dynamic Team that is shaping the new delivery of healthcare.
Demonstrated analysis and critical thinking and skills, with strong knowledge of product and benefit plan configuration on a business owned and maintained platform. Ideal candidates understand the interaction of benefits, provider networks and claims adjudication outcomes.
- Communicates product features and fundamental components to the organization that reflects the product and responds to the needs of various “stakeholders” (i.e., employees, customers, shareholders) while communicating the need and rationale for policies and standards.
- Represents Medicare NextGen Product and Benefit Configuration capabilities and strategy in cross functional meetings and related project activities, e.g. Commercial Product and Marketplace Offerings for Individual bid filings, Legislative Review Committee, and Operational Support areas.
- Collaborates with market segments to develop and implement plans and product features to achieve segment product strategies and achieve marketplace advantage.
- Serves as project manager and/or participant for selected projects.
- Independently manages mid-sized product enhancements, including defining new enhancement requirements and feature with the application vendor and testing and sign-off of delivered capabilities.
- Ensures that the Product & Benefit configurations are designed, developed, implemented and maintained from a product and business/customer point of view.
- Ensures maximum reusability across standard plans and offerings to enable efficiency and accuracy in delivery and speed to market.
- Performs research and analysis on legislative, competitive and industry issues to recommend new products or product enhancements.
- Participates in idea generation and project vision session for the development of new products and product enhancements.
- Gathers and analyzes feedback in support of performance analysis for products and continual improvement.
- 2-3 years developing automation BOTS and/or databases
- 3-5 years experience with Project Management skills.
- Knowledge of claim handling and associated processes such as provider contracting.
- Strong analytical skills.
- Proficiency with Excel.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
- 2 years or more of experience with Health Rules Payor technology platform
BS and/or IT Certification
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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