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Provides support for significant
product and benefit initiatives. This includes all new Exchange
Market product offerings that will be implemented on the NextGen
Successful candidates will have a mix of product and benefits
knowledge and it’s use in claims adjudication processing. If your
goal is to combine your strong healthcare product/benefit
knowledge, with a bent for analytic and technical implementation,
then this is the ideal job for you. You will determine the best
approach for driving the desired benefit outcomes in claims
processing and provider payment. Experience with coding standards,
ICD 10, CPT and HCPC codes would be beneficial. You will also need
to evaluate the impact of CMS and state legislation on benefit
plans. This is a unique opportunity to be on a dynamic Team that is
shaping the new delivery of healthcare.
Provides support for significant product initiatives. May
independently manage midsize product enhancements. Demonstrated
project management skills, with knowledge of product and
> Communicates product features and fundamental components to
the organization that reflects the product and responds to the
needs of various “stakeholders” (i.e. employees, customers,
shareholders) while communicating the need and rationale for
policies and standards.
> Represents product strategy in cross functional project
activities, e.g. ID card workgroup & Legislative Review Committee.
Collaborates with market segment to develop and implement plans to
achieve segment product strategies and drive membership growth.
Participates and/or facilitates cross enterprise work group
sessions to support individual exchange bid process and subsequent
delivery of products and benefit plans for Open Enrollment and
claims adjudication and servicing.
> Serves as project manager and/or participant for selected
> Ensures that product and benefit configuration is designed,
developed, tested and implemented per Product Strategy, Clinical
Policy and Compliance/legislative requirements.
> Performs research and analysis on legislative impacts, and
recommends approaches to support using consistent and highly
> Participates in idea generation and project vision session
for the development of new products and product enhancements.
Gathers and analyzes feedback in support of performance analysis
for products and continual improvement.
3-5 years related work experience. Bachelor's degree or
> In-depth understanding of the Medicare regulatory
environment, and impacts to benefits and claims adjudications.
>Knowledge of claim handling and associated processes such as
>Strong analytical skills, and ability to apply concepts into
> Very proficient in use of Excel.
> Knowledge of industry claim coding and
Additional Job Information
Strong Project management skills.
Adapt at time management of multiple concurrent assignments
In-depth understanding of the regulatory environment and
industry coding standards related to claims submission.
Bachelor's degree or equivalent experience
Percent of Travel Required
0 - 10%
Aetna, a CVS Health company, 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
We are committed to maintaining a diverse and inclusive
workplace. CVS Health is an equal opportunity and affirmative
action employer. We do not discriminate in recruiting, hiring or
promotion based on race, ethnicity, gender, gender identity, age,
disability or protected veteran status. 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.
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inclusion and belonging. 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 comply
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Changing the future of health care at CVS Health
It's a New Day in Health Care at CVS Health
About CVS Health 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 are an equal opportunity and affirmative action employer. We
do not discriminate in recruiting, hiring or promotion based on
race, ethnicity, gender, gender identity, age, disability or
protected veteran status.