Senior Plan Builder Dual Entry Team

Job DescriptionProvides plan benefit review, interpretation and systematic setup essential for online viewing and processing related to Customer Service, Claims, Enrollment, Billing and Reporting in support of internal and external partners.Required QualificationsFundamental Components Reviews benefit provisions to ensure compliance with state and federal mandates. Evaluation process may also include assessment of summary plan descriptions and other related documents prepared internally or externally by clients. Develops and executes implementation strategy consistent with client expectations; Ensures strategy is administered in accordance with all performance guarantee arrangements. Uses critical thinking and extensive knowledge of Meritain's system and processes to evaluate impact of client requested exceptions and develops reasonable alternatives to satisfy client's needs while minimizing impact on Meritain's system and operations; Identifies, communicates and tracks cost sensitive items not included as part of the standard process and highlights them for consideration in the determination of rate adjustments or renewal activity. Collaborates on review, analysis and development of recommendations for the design of complex account and benefit structures based on customers' objectives and Meritain's system. Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.) Effectively manages implementation and provides direction to fellow team members ensuring success of overall implementation process Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsBackground/Experience Desired 1st level Plan Build experience Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred) Meritain system experience Detail oriented Highly organized Good communication skillsEducation Bachelor's degree or equivalent work experienceBusiness OverviewBring your heart to CVS HealthEvery 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.

Created: 2025-09-06