- Entry level
- No Education
- Salary to negotiate
Manage Anthem business initiatives with strategic and operational impact across multiple different channels, within the MCO teams
Includes facilitating meetings, tracking tasks/owners, obtaining status, keeping colleagues on track, and escalating when appropriate
Ability to read-out to Advisor and Manager levels, when necessary
Ability to support initiatives that range between medium to high in size and complexity
Coordinating between multiple MCO or non-MCO teams for progress against shared objectives
Act as internal POC for assigned communication types
Provide assistance with issue resolution, as needed
Requirement to work both within a team dynamic but also affords the ability to work independently
The Medicare Part D Explanation of Benefits (EOB) department is responsible for producing a monthly Beneficiary mailing containing the summary of claim activity. The Member Communication Sr. Consultant is responsible for providing the Med D EOB department operational and testing support for Anthem with strict adherence to departmental processes, testing guidelines, Centers for Medicare and Medicaid Services (CMS) guidelines and recommendations, under the guidance of the EOB Production Manager.
As a Member Communication Sr. Consultant you will:
•Provide and develop operational oversight of quality and testing standards for Anthem, review and perform test on all Anthem programs prior to implementation to verify consistency and conformance to departmental guidelines
•Conduct a quality assurance review on CMS Explanation of Benefits (EOB) Anthem documentation to ensure the monthly EOB mailing continues to meet CMS guidelines and Client expectations
•Review cycles of Anthem proof samples that are generated by the Print Vendor and ensure quality and accuracy
•Research errors and work to either correct discrepancies internally or provide necessary Anthem mapping/coding updates to the print vendor
•Provide Anthem mapped document templates to Print Vendors for EOB production
•Work with Anthem designated internal partners on the development of data files
•Review Anthem Data files provided by IT for accuracy
•Research claim and balancing issues specific to Anthem
•Provide support for Anthem Medicare Part D EOB audits, service level agreements and performance guarantees.
•Provide technical advice and support specific to Anthem, on data analysis and correction, training and problem solving
•Collect and compile statistical quality/operational data and prepare reports to communicate outcomes of quality assurance and operational activities, to be completed timely and accurately in order to meet/exceed internal customer and client expectations; in support of Anthem performance guarantees, service level agreements and submission deadlines
- 3+ years of relevant quality assurance and analytical skills
- 2+ years of proven experience with MS Excel, Access and Word, Adobe Suite
Experience in the PBM Industry and/or Medicare Part D Services
Verifiable High School diploma or GED is required.
It’s a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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