Dual Entry Plan Builder

Job DescriptionEssential Qualifications and Functions: Candidates will provide plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. Meritain's proprietary system provides a benefit solution for customized benefit plans. Plan Builders must possess an analytical system coding ability to translate plan benefits into system data coding. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners. Provides plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners. Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans rather than standard offerings. Participate and engage in discussion with Clients related to benefit interpretation. Advising on State and Federal Mandates as well as system capabilities. Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation. Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients. 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. Uses business knowledge and experience to make plan design and processing recommendations when working with Clients. Evaluates 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.), this is similar to entry level IT programming. Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.) Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting.Required QualificationsKnowledge of: Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred) Experienced with various data systems (DOS systems a plus)Skill In: Salesforce Medical Terminology Ability To: The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits. Be highly organized and able to quickly prioritize multiple assignments with high quality results. Should have good communication skills with the ability to express complex concepts in a clear and concise manner. Should have a high attention to detail and accuracy while focusing on overall project deliverables. Should have the ability to remain flexible yet focused during stressful situations. Should possess good analytical and problem solving skills. Should be comfortable multi-tasking, they will be working on more than one client at a timeCOVID 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 QualificationsKnowledge of: Citrix, Outlook, Microsoft TeamsSkill in: System Programming, ExcelAbility To: Work independently as well as a group setting. Adapts well to change.The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits. This person should be highly organized and able to quickly prioritize multiple assignments with high quality results. This person should have good communication skills with the ability to express complex concepts in a clear and concise manner. This person should have a high attention to detail and accuracy while focusing on overall project deliverables. This person should have the ability to remain flexible yet focused during stressful situations. This person should possess good analytical and problem solving skills.Education5 years healthcare industry experience with benefitsBusiness 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