Client Services, Plan Build

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

We are seeking a detail-oriented and strategic professional to join our team in supporting benefit administration and system configuration for internal and external partners. This role is critical in ensuring accurate plan setup, compliance, and seamless processing across Customer Service, Claims, Enrollment, Billing, and Reporting functions.

Key Responsibilities:

• Review, interpret, and configure plan benefits for online viewing and processing.
• Utilize Meritain's proprietary system to perform analytical coding for customized plans beyond standard offerings.
• Develop and execute implementation strategies aligned with client expectations and performance guarantees.
• Consult with internal stakeholders on complex benefit administration, recommending solutions to minimize manual processes and client disruption.
• Ensure compliance with state and federal mandates through benefit provision reviews and evaluation of summary plan descriptions and related documents.
• Provide recommendations for plan design and processing improvements based on business knowledge and client needs.
• Collaborate on the analysis and design of complex account and benefit structures to meet customer objectives.
• Execute system setup and map client-level benefits to industry coding standards (ICD-10, Place of Service, Healthcare Reform), similar to entry-level IT programming.
• Gather and assess feedback from internal and external customers to drive continuous improvement in renewal processes and system tools.
• Demonstrate Salesforce proficiency for cross-functional communication and executive-level status reporting.

Required Qualifications:

• 3+ years of experience in healthcare (Quality, Claims, or Plan Build preferred).
• Experience with various data systems (DOS systems a plus).
• Knowledge of medical terminology.
• Highly organized with the ability to prioritize multiple assignments and deliver high-quality results.
• Strong communication skills with the ability to explain complex concepts clearly and concisely.
• Exceptional attention to detail and accuracy while maintaining focus on overall project deliverables.
• Ability to remain flexible and focused under pressure.
• Strong analytical and problem-solving skills.

Preferred Qualifications:

• 5+ years of experience in healthcare (Quality, Claims, or Plan Build preferred).
• Salesforce experience.
• Ability to research beyond the first solution to identify root causes of issues.

Education:

• Highschool Diploma or GED

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

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 people

We 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.

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