CVS Health

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Member Communication Consultant

at CVS Health

Posted: 10/11/2019
Job Reference #: 1089305BR

Job Description

Job Description
The Medicare Part D Explanation of Benefits (EOB) department is responsible for producing a monthly Beneficiary mailing containing the summary of claim activity. The Member Communication Consultant is responsible for providing the Med D EOB department operational and testing support with strict adherence to departmental processes, testing guidelines, Centers for Medicare and Medicaid Services (CMS) guidelines and recommendations, under the guidance of the EOB Production Manager.

As a Member Communication Consultant you will:

- Provide and develop operational oversight of quality and testing standards, review and perform test. on all programs prior to implementation to verify consistency and conformance to departmental guidelines.
- Conduct a quality assurance review on CMS Explanation of Benefits (EOB) documentation to ensure the monthly EOB mailing continues to meet CMS guidelines and Client expectations.
- Review cycles of proof samples that are generated by the Print Vendor and ensures quality and accuracy.
- Research errors and work to either correct discrepancies internally or provide necessary mapping/coding updates to the print vendor.
- Provide mapped document templates to Print Vendors for EOB production. Work with internal partners on the development of data files. Review Data files provided by IT for accuracy.
Research claim and balancing issues. Provide support for Medicare Part D EOB audits, service level agreements and performance guarantees.
- Provide technical advice and support on data analysis and correction, training and problem solving.
- Collect and compile statistical quality/operational data and prepare reports to communicate outcomes of quality assurance and operational activities, to be completed timely and accurately in order to meet/exceed internal customer and client expectations; in support of client performance guarantees, service level agreements and submission deadlines

Required Qualifications
- 1+ years of relevant quality assurance and analytical skills
- 2+ years of proven experience with MS Excel, Access and Word, Adobe Suite

Preferred Qualifications
- Ability to handle multiple projects at a time and identify, analyze and solve practical problems taking into account relevant factors and a wide variety of concrete variables. Demonstrate the ability and willingness to work in an ambiguous and changing environment to meet strict deadlines.
- Ability to be part of a team environment as well as work independently with limited direction from management, and be self motivated and a problem solver.
- Excellent oral and written communication skills. Excellent Interpersonal skills, and have experience in project management. Support junior team members by acting as a knowledge resource. Understand and ensure end to end regulatory compliance with federal reporting requirements.
- Exposure to SAS is desired
- PBM or Healthcare experienced

HS Diploma or GED required
Bachelor's Degree preferred

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.

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. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

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 assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

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