Prior Carrier File Load Analyst

Job Title

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 Facilitates the loading of Prior Carrier Plan accumulators or HRA contributions, via electronic data files or manual entry from prior plan Explanation of Benefits (EOBs), to assure members are given prior carrier credits, applicable HRA contributions and/or to allow for Stop Loss filings.

• Monitors and manages internal installation process and maintains case tracking tools to meet clients expectations and business goals (UAT and auditing are performed on each client load.)
• If required, communicates revisions essential for supporting and guarding the plan against unintended liability. Review data files within 24 hours to determine if the file is complete and contains the data elements required for loading.
• Consults and communicates with internal constituents regarding the details associated with new business and revision activity in a timely manner and validates account structure. System mapping required to load the data files, including but not limited to:
• creating a thorough test plan and performing the User Acceptance Testing (UAT) associated with the ticket.
• Providing the applicable date ranges to be used
• Loading the applicable details on type of claims to be loaded (medical, vision, Dental, Rx)
• Loading the applicable coding for inclusion or exclusion claims for stop loss filing
• Completes required data input into performance measurement system in support of Key business and management initiatives. (tracking is done in Salesforce.)

Required Qualifications

• 1 year healthcare industry experience with benefits interpretation.
• Proficient in Excel.

Preferred Qualifications

• Healthcare industry experience (Claims, and or Plan Build preferred).
• Detail oriented.
• Thorough understanding of claim benefits.

Education

• High school diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.00

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.

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