At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
This position is responsible for the processing of Medicare members eligibility discrepancies between the Medicare Enrollment Plan System and the Centers for Medicare and Medicaid (CMS) utilizing policy guidelines and experience of member enrollment rules. The primary focus will be on the PDP/SSI line of business, but not limited to that as the team is also responsible for MAPD/Aetna work. Key responsibilities will include processing discrepancies, providing trending and other pertinent feedback to leadership, reviewing Policy and Procedures for accuracy, maintaining expected production and quality standards and the ability to work in multiple systems (FACETS, EMA, MP (MNG) etc.)
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Required Qualifications
- Knowledge of the SSI systems (FACETS, EMA) as well as the Aetna systems (Aetna systems is a plus)
- Demonstrates working knowledge of standard enrollment processes, election period hierarchy.
- Ability to learn multiple functions including enrollment reconciliation, reconciliation of the Late Enrollment Penalty Status (LEP), Hospice status, gender and date of birth discrepancies and other issues.
- Ability to provides "root cause" analysis and process improvement opportunities to the management team.
- Helps the leadership team create, review and prepare for various audits. (SOX, CMS, Internal)
- Must be a team player
- Must have strong verbal and written communication skills
- Must be able to work independently
- Ability to prioritize tasks/work effectively.
- Strong organization skills.
- Problem solving skills.
- Attention to detail and accuracy
- Proficient in Microsoft Word, PowerPoint, Excel, Outlook and Teams
High School Diploma or equivalent Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$17.00 - $28.46This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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 and many other benefits depending on eligibility.