CVS Health

Receive alerts when this company posts new jobs.

Similar Jobs

Job Details

Benefits Design Advisor

at CVS Health

Posted: 5/25/2020
Job Reference #: 1270822BR
Keywords: management

Job Description

Job Description
As the Benefits Design Advisor you will have the overall responsibility for the Benefit Design within the Heath Plan Market Segment for Medicare/Medicaid/Commercial/Exchanges line of business. You will need to bring with you, a strong technical knowledge to focus on the roll out of automation strategies. Your focus will be responsible for driving the development of an automated approach to automate the creation of client benefits through a business rule engine. You will also be responsible for the overall communication to leadership on the status and overall quality of Design for the Health Plan Client Services Team. Your role will entail proactive planning, effective communication, coordination and project management of select organizational initiatives, action tracking and follow-up, and coordinating benefit automation projects in support of the business unit. You will be responsible for ensuring organizational processes are optimally aligned and coordinated between groups and projects. Some of your key tasks will include:

- Independently making decisions by applying sound judgment based on business principles and supporting data facts
- Inspiring change through the organization
Driving high level automation solutions
- Training and mentoring members of the team on technical and automation concepts, initially regarding business rule engines
- Collaborating with technical teams to design, develop and drive automated solutions to support business processes

Focus areas include collaboration with partner organizations like IT and Clinical Client Services to create standard methodologies, design templates, quality improvement, procedures, workflow management, and increase level of automation. You will act as an authority to gather and coordinate automation requirements, support and analyze requests from the requirements teams, translate client requirements into our adjudication system, staff training documentation and policy and procedure documentation. You will collaborate with internal partners, peers and staff to ensure all work is done accurately and on time. Your success will be measured by your ability to effectively communicate and collaborate with key partners and deliver your projects/assignments across the finish-line. You will operate in a dynamic environment with tight deadlines. Your ability to resolve ambiguous requests will also contribute to your success.

Required Qualifications
* 5+ years of experience in PBM adjudication functionality and plan design
* 2 or more years of proven project leadership experience, with ability to work in a dynamic team environment while meeting deadlines
* Ability and Flexibility to Travel up to 20% is required

Preferred Qualifications
* Advanced knowledge and experience in RxClaim
* Adjudication is strongly desired
* Benefit Builder experience strongly desired
* Ability to work effectively across several functional business areas
* Experience working in a client facing role
* Must be disciplined in operational excellence with the ability to drive improvements, optimize the organization’s performance and instill accountability for quality
* Demonstrable experience fostering a strong, consultative workforce

* Bachelor's degree is required
* Equivalent work experience may substitute

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.

We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!