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
The Plan Sponsor Liaison serves as the Single Point of Contact (SPOC) - Subject Matter Expert (SME) for our customers, brokers, consultants, and internal Aetna constituents. The Plan Sponsor Liaison will respond, manage, and resolve escalated and complex global issues for claims/calls and plan sponsor support teams.
The Plan Sponsor Liaison will proactively identify and surface customer and plan issues for resolution while acting as a liaison to communicate workflow results, ideas, and solutions. The Plan Sponsor Liaison will work with cross-functional business units and vendors to support the customer’s needs; promotes collaboration among constituents and represents a professional image of the company.
What you will do
- Assists with establishing and implementing results-based programs and innovative initiatives for the plan sponsor area, under general supervision.
- Applies in-depth knowledge of the plan sponsor work area to offer feedback for decisions and innovation strategies that enhance organizational growth and visibility.
- Examines escalated member-specific issues and/or broader plan administration matters as the single point of contact to provide swift resolution.
- Develops complex customer service account management plans for each account and implements plan for both new and existing accounts.
- Coordinates complex installations of new and existing accounts for the site by attending implementation planning/process meetings.
- Develops responses to requests for proposal (RFPs) and attends prospects calls.
- Configures processes and assignments for onsite and customer visits.
- Supports the installation of new and existing accounts for the site by attending implementation planning/process meetings.
- Proactively resolves issues with account executives, sales representatives, installation managers and the claims office as appropriate.
- Assist customers and sales in understanding the impacts of non-standard benefits.
- Analyzes constituent data, identifies trends and issues.
- Creates and presents information to various-internal and external constituents.
- Manage and review multiple claim reconciliation reports.
- Routine meetings with assigned customer.
- Create & maintain training support for customer service reps and claim benefit specialist.
- Initiates Provider outreach calls.
- Creates, tracks, and resolves cases in Salesforce.
- Salesforce T4T administration / new customer installation.
- Create relationships with International Departments of our top providers.
- Review and maintain eligibility process with clients.
- New implementation support.
- Assist with Client visits, prepares presentations.
Required Qualifications
- Bi-Lingual Spanish.
- 2-4 years of experience in the health insurance industry.
- 2-4 years of experience working with claims and benefits.
- 3+ years of experience in Microsoft Office (PowerPoint, Excel, Teams, Word, Outlook).
- 1+ years of GPS (Guide Personal Service) exposure and usage.
Preferred Qualifications
- Demonstrates strong consultative skills and ability to influence constituents.
- Strong leadership and project management skills.
- Auto adjudication knowledge (e.g., number of claims affected on non-standard plans, knowing when a benefit auto adjudicates).
- Strong and effective communication skills (verbal, written, presentation).
- Time management and organizational skills.
- Ability to adapt and work in a fast paced, evolving environment.
- Strong understanding of multiple aspects of the plans and products (e.g., CCI coding).
- Critical thinking and decision-making skills.
- Strong knowledge of Aetna Standards.
- Ability to work independently and in a team environment.
- Collaborate effectively to identify and implement action plans to address different situations.
- Manage multiple priorities and tasks while maintaining the ability to honor commitments.
Education
- Associate’s degree or equivalent work experience (HS diploma + 2 years relevant experience).
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $122,400.00This 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 07/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
