Sr Analyst, Plan Sponsor at CVS Health

Hartford, Connecticut, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

3 years experience in Group Medicare Business and Medicare Advantage Plans and Products
Strong Leadership and Communication skills (verbal, written and/or presentation)
Critical thinking, problem solving and decision-making skills
Demonstrate prior experience in consultative skills and the ability to influence constituents for positive outcomes and initiatives

Responsibilities

Serve as the Single Point of Contact for Aetna Medicare Advantage servicing to Plan Sponsors' human resources personnel, their TPAs, Brokers and Consultants, in addition to all Aetna back-office teams
Control daily communication between departments or individual policyholders regarding benefit plan administration
Direct workflow to respond, manage, and resolve escalated and complex global issues for Claims/Calls, PSS, and health plan back-office operations
Conduct random ID card quality review, handle standard customization requests and updates to the Plan Sponsor Profile Pages for assigned book of business
Act as primary liaison between Plan Sponsors, their TPAs, Brokers, Consultants, Aetna Medicare Account Management Team, Aetna Commercial Account Management Teams and back-office departments regarding benefit plans, eligibility, claims, billing, and general benefit plan administration
Assist with establishing and implementing results-based programs and innovative initiatives for Plan Sponsors, under general supervision
Apply in-depth knowledge of Plan Sponsor/back-office areas to offer feedback for decisions and innovation strategies that enhance organizational growth, visibility, member retention and customer satisfaction and trust
Examine escalated member-specific issues and/or broader plan administration matters as the single point of contact to provide swift resolution
Develop complex customer service account management plans for each account and implement plans for both new and existing accounts
Coordinate service delivery of new and existing accounts by attending implementation planning/process meetings
Ensure ID card Quality, timeliness, and Performance Guarantee for assigned book of business
Manage Plan Sponsor Profile Page and support Group Contact Center of Excellence for projects, workflow support and projects to enhance the member experience and customer satisfaction
Assist with Member Open Enrollment Meetings and customer site visits
Proactively identify and surface customer and plan issues for resolution while acting as a liaison to communicate workflow results, ideas, and solutions
Proactively resolve issues with account managers, sales representatives, and other Aetna back-office teams as appropriate
Identify most urgent business problems, obtain necessary information, accurately identify root causes, and generate solutions
Initiate and maintain partnerships with others throughout the organization, encourage cooperation by promoting common goals and building trust, and inspire, support, and initiate cross-functional activities

Skills

Benefit Plan Administration

Claims Management

Stakeholder Communication

Workflow Management

Escalation Resolution

Medicare Advantage

Plan Sponsor Liaison

Eligibility Management

Billing Administration

Account Management

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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