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.

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 MAPD/Aetna line of business, but not limited to that as the team is also responsible for PDP/SSI. 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 (MP (MNG), FACETS, EMA, etc.)

Required Qualifications

Knowledge of the Aetna systems (MP) as well as the SSI systems (SSI 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), LIS (Low Income Subsidy) Hospice status, gender and date of birth discrepancies and other issues

Ability to provide “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

Preferred Qualifications

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

Education

High School Diploma or equivalent

Pay Range

The typical pay range for this role is:

$17.00 - $34.15

This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/15/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.