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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

As a Representative II Benefits Setup, you will be part of an extremely talented team within our Aetna Benefits and Testing Client Services organization at CVS Health. You will be accountable for analyzing client requests and performing the necessary benefits testing and quality assurance. You’ll work alongside BRMs, Benefits Coders and Testers, as well as our Account Management and Implementation teams to deliver high quality support to our vast number of clients. Extreme attention to detail is important for this role, as your testing and quality assurance activities will impact not only the federal and state programs that we participate in, such as Medicare Part D and Medicaid, but also the members we provide service to. As a Representative III Benefits Setup, you will be accountable for executing a test strategy based on client intent and meeting or exceeding turnaround time and quality standards. You will be expected to develop and execute high quality test cases and have clear understanding of the client intent to prevent issues leaking into production. Your tasks will include query and claim validation and raising internal defects for requirements not meeting the client intent. You will be required to work with the plan benefits coding team in resolving issues, driving expected results and meet project target dates as required by management. Our organization offers a benefit package including vacation and holiday paid time off, health/dental/vision insurance, work/life balance, employee discounted stock purchase program, 401K, tuition reimbursement, and employee discounts at all CVS stores. Check out all our benefits at CVS Health Total Rewards (https://jobs.cvshealth.com/benefits/) .

Representative II Benefits Setup responsibilities​

+ 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.

Required Qualifications

+ 1-3 years of related work experience required in data analysis, auditing, information systems, quality assurance or other related background.

+ Previous work experience in a RxClaim applications, PBM, Medical Claims, Health Insurance, Pharmacy, or Benefits.

+ Advanced Microsoft Excel skills for data analysis; proficient in using other Microsoft Office applications.

+ Great Knowledge and experience with Quality Assurance and testing in healthcare domain with wide understanding of Manual and automated testing.

+ Great investigating skills and attention to detail. Ability to define problems, collect data, establish facts, draw valid conclusions, and perform the necessary Root Cause Analysis.

+ Able to thrive and be successful in an energetic, operational environment that is client-centric.

+ Well organized and able to effectively prioritize work and meet the schedule.

+ Ability to communicate findings with team, project leaders and SMEs.

+ Self-motivated and focused on ensuring client intent is met.

Preferred Qualifications

+ Great mathematical skills.

+ Technical aptitude, comfortable working in database systems.

+ Proactively identify opportunities to improve efficiency/quality.

+ Able to deliver per the timelines.

+ Work large / complex clients to ensure 100% test coverage and review for proper set-up that meets client intent.

+ Accountable for always maintaining your SalesForce.com (SFDC) queue.

+ Regression Testing, Query Testing and AS400 experience preferred.

+ Experience with data mining large datasets and critically analyzing for trends and accuracy.

+ Auditing experience

+ Proficient in analyzing and executing clinical and non-clinical client work requests.

+ Able to thrive and be successful in a productive, operational environment that is very client centric, where there is high variability between clients’ plan designs.

+ Demonstrated ability to make decisions on one’s own initiative by applying sound judgment based on business principals and supporting data facts.

+ Demonstrated ability to be accountable and independent. Results accountable and performs at a high level with minimal supervision.

+ Self-motivated and detail oriented focused on ensuring client intent is met and minimizing financial exposure.

+ Able to apply logical thinking and investigating skills to research claims issues, formulate a strategic approach to efficiently build plans by performing analysis, and then execute and validate the plan build.

+ Able to seek out and find solutions on one’s own initiative.

+ Able to prioritize issues and operate in environment of regulatory compliance and audit.

+ Well organized and able to effectively prioritize work.

+ High level of attention to detail.

+ Able to meet aggressive turnaround time standards and client performance guarantees coupled with excellent quality.

+ Able to effectively work within a team.

+ Flexible in adapting to change.

Education

Bachelor's degree preferred/specialized training/relevant professional qualification/equivalent experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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.

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/benefits

We anticipate the application window for this opening will close on: 05/18/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.