Experienced Remote Associate Plan Builder – Healthcare Benefits Administration and Claims Adjudication Specialist

Introduction to CVS Health and Our Mission At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle underscores our commitment to delivering human-centric healthcare solutions in a rapidly evolving world. Our brand, with heart at its core, conveys a personal message that emphasizes the importance of how we deliver our services, not just what we deliver. As part of our team, you will be empowered to play a pivotal role in transforming our culture and accelerating our ability to innovate and provide personalized, convenient, and affordable healthcare solutions. About the Role: Associate Plan Builder We are seeking an experienced and highly skilled Associate Plan Builder to join our team at Meritain Health, a CVS Health company. As an Associate Plan Builder, you will be responsible for providing plan benefit review, interpretation, and systematic setup essential to the processing of our claims adjudication system. Your expertise will be crucial in ensuring that our proprietary system provides a benefit solution for customized benefit plans, aligning with the needs of our clients and internal stakeholders. Key Responsibilities: Provide plan benefit review, interpretation, and systematic setup to facilitate the processing of our claims adjudication system, ensuring alignment with client needs and internal stakeholders. Utilize Meritain's proprietary system for analytical coding of detailed customized plans, rather than standard offerings, to meet the unique needs of our clients. Participate in discussions with clients related to benefit interpretation, advising on State and Federal Mandates, as well as system capabilities, to ensure compliance and optimal plan design. Facilitate client-facing review of plan setup, walking through all benefits to assure alignment of benefit interpretation and ensuring that client needs are met. Consult and advise internal stakeholders on complex benefit administration, providing guidance on options to minimize manual processing and disruption for clients. Review benefit provisions to ensure compliance with state and federal mandates, evaluating summary plan descriptions, and other related documents prepared internally or externally by clients. Use business knowledge and experience to make plan design and processing recommendations when working with clients, ensuring that their objectives are met while minimizing impact on Meritain's system and operations. Evaluate the impact of client-requested exceptions and develop reasonable alternatives to satisfy client needs while minimizing impact on Meritain's system and operations. Collaborate on the review, analysis, and development of recommendations for the design of complex account and benefit structures based on customers' objectives and Meritain's system. Execute system setup and mapping of client-level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), utilizing skills similar to entry-level IT programming. Solicit and assess internal and external customer feedback to enhance continuous quality improvement on the implementation process, including system tools and resources. Demonstrate Salesforce proficiency and understanding for cross-functional communication and executive-level status reporting. Essential Qualifications: Healthcare industry experience (Customer Service, Claims, and/or Plan Build preferred) Experienced with various data systems (DOS systems a plus) Medical Terminology knowledge Highly organized with the ability to quickly prioritize multiple assignments with high-quality results 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 Preferred Qualifications: 5+ years of experience working in the Healthcare industry Salesforce experience Ability to research and look beyond the first right answer to find the root of a concern Education: A High School Diploma or GED is required for this role. What We Offer: In addition to a competitive salary, our company provides a comprehensive range of benefits, including medical, dental, and vision coverage. Eligible employees may enroll in our 401(k) retirement savings plan and Employee Stock Purchase Plan. We also offer a fully paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs. Our employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Career Growth Opportunities and Learning Benefits: At CVS Health, we are committed to the growth and development of our employees. As an Associate Plan Builder, you will have access to a range of training and development programs, including free development courses and education assistance. Our company is dedicated to helping you achieve your career goals and providing you with the skills and knowledge necessary to succeed in your role. Work Environment and Company Culture: Our company culture is built on a foundation of respect, empathy, and inclusivity. We value diversity and believe that our differences are what make us stronger. As an Associate Plan Builder, you will be part of a dynamic and supportive team that is passionate about delivering exceptional healthcare solutions. Our remote work environment provides the flexibility and autonomy to work from anywhere, while our digital collaboration tools ensure that you stay connected with your colleagues and stakeholders. Compensation and Perks: The typical pay range for this role is $43,888.00 - $93,574.80 per year, depending on experience and location. In addition to your salary, you will be eligible for a CVS Health bonus, commission, or short-term incentive program. Our company also offers a range of perks, including a CVS store discount and discount programs with participating partners. Conclusion: If you are a motivated and experienced healthcare professional looking for a new challenge, we encourage you to apply for the Associate Plan Builder role at Meritain Health. As a key member of our team, you will have the opportunity to make a meaningful impact on the lives of our clients and stakeholders. Don't miss this chance to join a dynamic and supportive team that is passionate about delivering exceptional healthcare solutions. Apply today and take the first step towards a rewarding and challenging career with CVS Health. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Apply for this job