Hartford, Connecticut

Job Description
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.

Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 158,300

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
- 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 Requirements

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.

Preferred Qualifications
- 2 years or more of experience with Health Rules Payor technology platform

BS and/or IT Certification

Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. See Job Description

Hartford, Connecticut

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.

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