Plan Testing Coordinator - Senior Claim Data Specialist
CVS Health
Raleigh, NCPosted over 1 year agoDiscoveredMatch locked
3+ years expBusiness Operations
About the role
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
This position will be responsible for managing the plan test inventory for all Commercial business segments. This position requires strong teamwork and communication skills, an understanding of ACAS,CCI, multiple database applications, along with strong technical & analytical ability. The Plan Test coordinator ensures plan set-up activities are performed correctly through careful comparison between Web-based Coverage Card Inquiry and the Automatic Claims Adjudication System and will serve as a key resource during the plan implementation process for the new and renewing customers.
Fundamental Components
The Plan Testing Coordinator position actively manages the plan testing inventory for the Commercial membership enrolled in ACAS. This position supports claim readiness, as testing is required for any new or revised plans, before claims can be released. Some of the key responsibilities for this position are listed below: • All test issues reported by the plan testers are reviewed by the testing coordinators and reported to the appropriate area for correction.
- Monitor Regional Plan Testing Mailboxes.
- Responsible for Regional ASSET QuickBase (loading plans/assignments for testing).
- Review/research plan testing errors.
- Report test issues to appropriate business area for correction (PCC/APC/MPSU).
- Notify Regional Liaisons when testing is completed and considered claim ready. Attend weekly OE Status calls.
- Provide updates on testing in their regions to necessary business areas.
- Provide daily support to plan testers on questions and clarification.
- Partner with BIM to maintain plan testing application tool.
- Maintain all test claim IDs and claim dates used during year.
- Provide feedback on trends to team lead and director.
- Respond to any segment operational teams, Plan Sponsor Services or APC teams, to ensure timely and accurate plan test all segment benefits (new business or renewal business).
Required Qualifications
- Strong business and organizational knowledge including 3+ years experience on ACAS platform with specific knowledge of medical plan set up and adjudication logic.
- Working knowledge of Web CCI, BPLV, Plan Sponsor Tool, EPDB and other affiliated systems.
- Strong analytical skills.
- Ability to complete multiple tasks and ensure all tasks are delivered within projected time.
- Critical Thinking and Problem Solving skills in a fast paced work environment.
- Flexibility in daily report handling to support other team functions as needed.
Preferred Qualifications
- Master user in MS Excel and QuickBase.
- Excellent written communication skills to complete necessary documentation and updates within multiple applications.
- Ability to work independently; effectively manage conflict and remain calm during stressful situations.
- Ability to be a team player and work cooperatively.
Education
- Associate's degree or equivalent experience.
Full time Pay Range
The typical pay range for this role is:$18.50 - $42.35This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: •
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan
.
•
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
•
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 05/03/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Not included in the source posting: about the role.
Skills
excel
Who can apply
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