Client Benefits Specialist Job Listing at CVS Caremark in Scottsdale, AZ
Job Category: Customer Service
Clinical Licensure Required : N/A
Job Type: Full Time Position Summary:
Investigate and resolve complex and sensitive service-related disputes. Perform customer call backs or create written correspondence to effectively close the issue.
Research and analyze participant claims activity, plan design, and CMS guidance in determining accurate claim payments, accumulations and resolution. Perform calculations or validation for claim payment/reconciliation determination for Medicare Part D across processing platforms. Execute accumulation adjustment and/or participant reimbursement. Work with various business units to resolve issues with enrollment, mail service processing and billing disputes. Responsible for meeting or exceeding turnaround time standards, productivity and quality expectations. Provide recommendations for improvements in customer service and administration to reduce or eliminate disputes Required Qualifications:
0-3 years of related work experience required. Knowledge, Skills & Abilities: Required * Ownership and results driven * Critical thinking/problem solving skills * Focused and thorough research skills * Customer focused * Aptitude for basic and analytical mathematics * Work effectively with business units, cross functional teams * Able to handle high volume receipts within defined turnaround times coupled with excellent quality * Proficient use Microsoft Office applications, e.g. Excel, Word * Ability to effectively work within a team * Flexible in adapting to change * Demonstrated ability to analyze data and determine conclusions * Ability to learn and apply increasingly complex concepts, policies and procedures * Ability to effectively plan, prioritize, organize time and workload * Skilled in identifying/solving issues and recommending process improvements * Ability to work successfully in a deadline-oriented environment * Excellent verbal and written communication skills Preferred Qualifications:
* Thorough understanding of Caremark system applications * Knowledge of healthcare industry * Good understanding of Medicare Part D CMS guidance and Sarbanes Oxley practices * Knowledge of claim adjudication principles Education:
Verifiable High School diploma or GED is required. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day.
As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
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