CVS Health

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Sr. Med D Quality Consultant

at CVS Health

Posted: 6/12/2019
Job Reference #: 999471BR

Job Description

Job Title :
Sr. Med D Quality Consultant
Job ID :
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Customer Service
Description :
Job Description
As a Quality Monitoring Senior Consultant, you will be responsible for providing analytical support for Medicare Part D paid and rejected claims monitoring. The emphasis will be on complex claims adjudication such as clinical programs, transition fill, drug coverage, RxClaim benefits coding and client's benefit plan designs. You will analyze moderate to complex claims to determine claims adjudication appropriateness aligned to regulatory requirements and client intent. You will propose and assist in the development of new and innovative rules, processes, and automation that bring positive impact to clients/members/CVS Health. You will also train and mentor Consultants.

Required Qualifications
3+ years of related work experience

1+ years of claim adjudication, benefit plan design, Medicare Part D or RxClaim adjudication experience

2+ years of experience with Microsoft Office, particularly Excel

Preferred Qualifications
Med D and/or RxClaim (AS400) experience preferred

Proven analytical skills and attention to detail

Ability to effectively define issues, collect data, establish facts, and draw valid conclusions

Ability to interpret and integrate CMS guidance into applicable processes

Proficient in analyzing specific types of moderate to complex claim transactions and proven experience in delivering accurate and precise results

Ability to work effectively cross-functionally

Excellent verbal and written communication, demonstrated ability to document and present concepts in a clear, concise and logical manner

Ability to meet deadlines with a variety of responsibilities

Ability to creatively solve problems when dealing with a variety of variables in situations where standard resolutions do not exist

High School Diploma or GED required

Bachelor's Degree strongly preferred or equivalent experience

Business Overview
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.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!