Irving, Texas

Job Description
We are looking for passionate, driven people who want to join a high energy and growing team that will make a difference in our customers’ lives and who is willing to work for Client Implementations and Process Improvements.

This is a Sr. Consultant position within the Testing Team. This individual will support Formulary, UM and Benefits testing, Smart Edit testing, regular Maintenance of business testing for the PBM and work with our internal customers along with other job duties as required. This Sr. Consultant will need to identify the best approaches and strategies for ensuring the accuracy of Formulary, UM and Benefits and could be requested to discuss test results with senior leadership across multiple lines of business.

This Sr. Consultant will serve as a subject matter expert (SME) for Formulary, UM and Benefits issues, which will include running queries and claims and analyzing Testing defects either within the Testing team or with our Internal Customers. This individual will be required to identify areas of improvement and will need to successfully engage internal business partners and leaders as needed; to resolve issues, drive results and meet project target dates as required by management.

This Sr. Consultant will participate in process improvements across multiple business units as required by Client Services leaders. This individual will work with Client Benefits, Membership Operations, Account Management and Implementation management along with senior leadership to improve the overall Quality of the Client Implementation experience

Required Qualifications
• Demonstrate ability to analyze data, verify accuracy and determine conclusions
• Ability to run the EzTest / EzQuery Tool and analyze the data spreadsheets
• Strong analytical skills and attention to detail. Ability to define problem, collect data, establish facts, draw
valid conclusions and perform the necessary Root Cause Analysis.
• Knowledge and experience with Client Operations in a PBM environment.
• Prioritize, manage multiple assignments, and direct the work of others to meet deadlines.
• Working knowledge of Microsoft Office applications including Word, Excel, Power Point and Access.
Experience with Visio, Project would be a plus.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.


Preferred Qualifications
• 4-5 years experience in Healthcare or a PBM desired.
• Excellent communication (Verbal and Written) and collaboration skills.
• Superior organization, project management, and prioritization skills.
• Courteous and professional demeanor with the desire and ability to work as a team.
• Strategic, forward thinkers with sound technical and analytical abilities.
• Ability to interact and influence with senior leadership of the organization.
• Firm understanding of Federal and State agencies and their role in Healthcare legislation.
• Firm understanding of Healthcare documentation and resource requirements.
• Deep knowledge in Health Plan benefit structures.
• Experience with SQL and Queries is preferred.
• Thorough and detailed knowledge of investigating, analyzing and effecting corrective action using experience to apply various methods and techniques that promote timely change and accountability.
• Strong analytical skills and attention to detail. Ability to define problem, collect data, establish facts, and draw valid conclusions.
• Knowledge and experience with Clinical Operations in the Medicaid and Medicare environment.
Ability to research, analyze and interpret CMS rules and regulations, then apply them to current work assignments.
• Working knowledge of Microsoft Office applications including Word, Excel, Power Point and Access
• Knowledge of RxClaim (AS400), EZQuery and EZTest tools

Education
Bachelor’s degree required; equivalent work experience may substitute.

Business Overview
At CVS Health, 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 strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. 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. See Job Description

Irving, Texas

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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