Experienced Grievance Analyst - Pending Case Review for Medicare Part D Grievances

Bring Your Heart to CVS Health: Join Our Team as a Grievance Analyst

At CVS Health, we're driven by a singular purpose: to bring our heart to every moment of your health. We're committed to delivering enhanced, human-centric health care that's both personal and convenient. As a Grievance Analyst in our Delegated Grievances team, you'll play a critical role in ensuring that our Medicare Part D grievance cases are resolved with the highest level of quality, regulatory compliance, and member satisfaction.

About the Role

We're seeking a highly skilled and detail-oriented Grievance Analyst to join our team in a remote capacity. As a Grievance Analyst, you'll be responsible for performing quality reviews on Medicare Part D grievance cases, ensuring that they're resolved according to regulatory requirements and meet our high standards for member experience. Your work will be critical in driving successful CMS and client audit results, as well as member satisfaction.

Key Responsibilities

• Perform quality reviews on Medicare Part D grievance cases to ensure accurate documentation, thorough research, and full resolution.
• Determine if cases meet regulatory requirements and our high standards for member experience.
• Return cases to grievance caseworkers for review and correction if they don't meet requirements.
• Report error trends to leadership to inform process improvements.
• Provide support to various operational teams within the Grievance department, as needed.
• Work grievance cases, perform initial quality reviews, and support grievance triage and assignment.

Essential Qualifications

To succeed in this role, you'll need:

• 2+ years of experience working in a customer service role with multiple computer applications and complex databases, including Microsoft Office products (Excel, Word, and Outlook).
• A minimum of 2 years of experience with Medicare Part D grievances and advanced knowledge of grievance processes.
• Proficiency in navigating Microsoft Word and Excel.
• Strong research skills and attention to detail.
• Intermediate to advanced knowledge of various Caremark systems, including MedHOK, PeopleSafe, the Source, and RxClaim.

Preferred Qualifications

While not required, the following qualifications will make you a more competitive candidate:

• Previous experience in Pharmacy Benefit Management (PBM) or a pharmaceutical-related industry.
• Experience working with Pending Case Review (PCR).
• Bachelor's degree.

Skills and Competencies

To excel in this role, you'll need:

• Excellent analytical skills and the ability to multitask.
• Strong organizational and time management skills, with the ability to prioritize tasks and meet turnaround time requirements.
• Receptiveness to constructive feedback and flexibility in adapting to change.
• Strong communication and interpersonal skills.

Career Growth Opportunities and Learning Benefits

At CVS Health, we're committed to helping our colleagues grow and develop in their careers. As a Grievance Analyst, you'll have opportunities to:

• Develop your skills in Medicare Part D grievances and regulatory compliance.
• Improve your analytical and problem-solving skills.
• Enhance your knowledge of Caremark systems and other relevant technologies.
• Take on additional responsibilities and contribute to process improvements.

Work Environment and Company Culture

At CVS Health, we pride ourselves on our culture of care and compassion. As a remote colleague, you'll be part of a team that's dedicated to delivering exceptional health care services. You'll enjoy:

• A flexible, remote work environment that allows you to work from anywhere.
• A collaborative and supportive team that's passionate about making a difference.
• Opportunities to develop your skills and advance in your career.
• A comprehensive benefits package that includes medical, dental, and vision coverage, 401(k) retirement savings plan, and Employee Stock Purchase Plan.

Compensation and Benefits

We offer a competitive salary range of $43,888 - $76,500, depending on your experience and qualifications. In addition to your base salary, you'll be eligible for a CVS Health bonus, commission, or short-term incentive program. Our comprehensive benefits package includes:

• Medical, dental, and vision coverage.
• 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs, education assistance, and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays throughout the calendar year.

Join Our Team

If you're a motivated and detail-oriented professional looking to make a difference in the healthcare industry, we want to hear from you. Apply now to join our team as a Grievance Analyst and help us bring our heart to every moment of your health.

Don't miss out on this exciting opportunity. We look forward to hearing from you!