Build and configure benefit plans so they work cleanly across customer service, claims, enrollment, billing, and reporting. If you’re sharp with benefit interpretation, detail-obsessed, and can manage implementations without chaos, this is a high-impact operations role.
About CVS Health
CVS Health is reimagining healthcare to make it more connected, convenient, and compassionate. This role supports Meritain by translating benefit documents into accurate system setup that helps plans process correctly for members, clients, and internal teams.
Schedule
- Full-time (40 hours/week)
- Remote
- Application window closes: 02/19/2026
What You’ll Do
- Review plan benefits and set up configurations for online viewing and processing across claims, enrollment, billing, reporting, and customer service
- Interpret benefit provisions and confirm compliance with state and federal mandates
- Assess summary plan descriptions and related plan documents (internal or client-provided)
- Develop and execute implementation strategies aligned to client expectations and performance guarantees
- Evaluate client-requested exceptions, recommend alternatives, and minimize operational/system impact
- Identify and track cost-sensitive items outside standard processes for rate/renewal consideration
- Collaborate on analysis and recommendations for complex benefit and account structures
- Use Meritain’s proprietary system to code detailed, customized plans (beyond standard offerings)
- Manage implementations and provide direction to team members to ensure successful delivery
- Facilitate client-facing reviews, walking through benefit setup to confirm alignment and interpretation
- Gather feedback and contribute to continuous improvement of implementation tools and processes
- Use Salesforce for cross-functional communication and executive-level status reporting
- Review coverage files during the first year to identify setup adjustments that improve auto-adjudication
What You Need
- 1–2 years healthcare industry experience (customer service, claims, and/or plan build preferred)
- Strong organization and the ability to prioritize multiple assignments with high-quality output
- Clear communication skills, including explaining complex concepts in a concise way
- High attention to detail and accuracy with a focus on project deliverables
- Ability to stay flexible and focused under stress
- Strong analytical and problem-solving skills
- Bachelor’s degree preferred (or HS diploma/GED with equivalent work experience)
Benefits
- Pay range: $46,988–$122,400/year (based on experience, education, geography, and other factors)
- Eligible for bonus/commission/short-term incentive programs (role-dependent)
- Medical plan options
- 401(k) with matching contributions and employee stock purchase plan
- No-cost wellness programs, counseling, and financial coaching
- Paid time off and flexible work schedules (eligibility-based)
- Family leave, dependent care resources, and tuition assistance (eligibility-based)
- Retiree medical access and additional benefits depending on eligibility
This one closes 02/19/2026, so if you’ve got any plan build or claims/benefits interpretation background, don’t drag your feet.
Accuracy is the whole game here. If that’s your superpower, run it.
Happy Hunting,
~Two Chicks…