Associate Plan Builder, CVS Health

CVS Health

Location:

United States, Plymouth

Category:

Customer Service

Contract Type:

Employment contract

Salary:

43888.00 - 93574.00 USD / Year

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Job Description:

The Associate Plan Builder is responsible for plan benefit review, interpretation, and systematic setup essential to processing claims adjudication within Meritain's proprietary system. The role involves engaging with clients, advising on mandates, facilitating review of plan setups, consulting internal stakeholders, ensuring compliance, and solving complex benefit administration issues. The position includes system coding of client benefits as well as Salesforce usage for cross-functional communication and reporting.

Job Responsibility:

Provides plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system
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
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
Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting

Requirements:

Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)
Experienced with various data systems (DOS systems a plus)
Medical Terminology
Be highly organized and able to quickly prioritize multiple assignments with high quality results
Must have strong 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
Analytical and problem solving skills

Nice to have:

5+ years’ experience working with Healthcare
Salesforce
Ability to research and look beyond the first right answer to find the root of a concern

What we offer:

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings
tobacco cessation and weight management programs
confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off
flexible work schedules
family leave
dependent care resources
colleague assistance programs
tuition assistance
retiree medical access

Additional Information:

Job Posted:

March 19, 2025

Expiration:

April 18, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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Associate Plan Builder