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CVS Health Representative III Benefits Setup in WORK FROM HOME, Georgia

Job Description

CVS Health as an opportunity for a Benefits Setup Representative III. As a Benefits Setup Rep III, you would be responsible for analyzing client benefit requests, determine best operational approach and perform coding. In this role you will be working with both internal and external partners. Critical thinking, creative problem solving, and strategic collaboration skills are a must. The Benefits Setup Rep III will also be responsible for meeting turnaround times, quality measurements and performance guarantees within the client’s plan benefit setup. Following policies and best practices relating to the job function by analyzing client documentation requests, determine the best operational approach and perform coding using RxClaim/AS400; a Prescription Benefit Management tool. This position is also expected to validate coding accuracy utilizing various tools and perform reporting functions to ensure no financial impact and that we are in compliance with regulatory standard and internal audits. This candidate will be a mentor to their peers, along with authenticating coding for accuracy by utilizing various tools. Address operational issues, identify solutions to resolve process issues and operational gaps as well as identify process improvement opportunities to make the processing of plan design requests more efficient. Focus on Med D and Exchange LOBs.

Required Qualifications

2+ years Healthcare, PBM or Pharmacy Environment2+ years of experience with AS400/RXClaim1+ years of experience with SalesForce.com (SFDC)Ability to deliver per the timelinesProficient use Microsoft Office applications, e.g. Excel, Word

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 10 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 45 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 10 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

  • 2+ years of Coding experience- 2+ years of Claims experience- Knowledge in Med D coding or similar is a plus- Knowledge of health care industry, Health Insurance, Retail or Pharmacy highly preferred.- Thorough understanding of RxCLAIM platform/system applications- Proficient in analyzing and executing clinical and non-clinical client work requests- Well organized with the ability to effectively and independently prioritize work- Excellent time management skills- Excellent interpersonal and collaborative skills with the ability to work in a team environment- Ability to work successfully in a deadline-oriented environment- Excellent verbal and written communication skills- Proficient use Microsoft Office applications, e.g. Excel, Word- Working knowledge of SalesForce.comEducation


High School Diploma or GED required

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.