This is a Representative III position within the Client Benefits testing team. This individual will work with cross-functional team and perform claim adjudication testing which will include running queries, claims and meet project dates as required by management.
This position is expected to support test activities for commercial clients as well as clients with federal/state programs such as Medicare Part D, Medicaid, Medicare Advantage Prescription Drug (MAPD), Retiree Drug Subsidies (RDS), Coordination of Benefits (COB), Employer Group Waiver plan (EGWP), HealthCare Reform, etc.
This position will be responsible for test execution activities for multiple lines of business (Medicare, Medicaid, Commercial & Exchange)
∙ Analyze client benefit requests, determine best operational approach and perform testing or quality reviews.
∙ Execute test beds and validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction.
∙ Log issues and defects found during testing in SFDC
∙ Responsible for meeting or exceeding turnaround time and quality standards.
∙ Research client benefit requests and raise issues/clarifications to internal partners to meet client needs
∙ Responsible for performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines.
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit
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2-3 year experience working in the PBM or related work experience in Quality Assurance
Strong analytical skills and attention to detail
Ability to analyze data, interpret requirements, establish facts and draw valid conclusions
Working knowledge of Microsoft Office applications including Word, Excel, PowerPoint, and AccessPreferred Qualifications
1-2 year experience working in PBM or managed care or healthcare industry preferred
Knowledge of RxClaim (AS400), EZQuery and EZTest tools
Excellent communication (Verbal and Written) and collaboration skills
Courteous and professional demeanor with the desire and ability to work in a team
Ability to interact and with project leads and SME’sEducation
Bachelor’s degree Preferred; equivalent work experience may substitute.Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.