Job Description
Title: Grievance Analyst
FCR
Location: Phoenix AZ US
Category: Plan Operations
Job Type: Fully remote
Salary: 40600.00 – 83400.00 /year
Job Description:
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
CVS Health has an exciting new opportunity within the Delegated Grievances team in Scottsdale, AZ. As a Grievance Analyst, you will be responsible for performing quality reviews on Medicare Part D grievance First Call Resolution cases to ensure the cases are resolved according to regulatory requirements and meet the highest expectations for a positive member experience. As part of the case review, you will determine if the case was documented accurately, if thorough research was completed and whether full resolution was provided to the member. If the case does not meet all requirements for a complete and accurate resolution of the case, it will be forwarded to a grievance caseworker to complete the resolution. The quality review performed by the Analyst in this position is critical for ensuring successful CMS and client audit results, as well as member satisfaction. The Analyst will also be responsible for reporting error trends to leadership so they can be addressed with internal partners. Lastly, this position will also include providing support to various operational teams within the Grievance department, as needed. This may include working grievance cases, reviewing member calls, and supporting grievance triage and assignment.
To be successful in this role you will need to be proficient in navigating Microsoft Word and Excel, detail-oriented along with having strong research skills. A successful Analyst is receptive to constructive feedback and flexible in adapting to change while effective in planning, prioritizing, and organizing their time and workload to achieve turnaround time requirements. The Analyst must have excellent analytical skills, the ability to multitask and be able to perform reviews quickly, while focusing on quality.
Required Qualifications
- 2+ years of experience working within a customer service role on several computer applications and complex databases for research, including Microsoft Office products (Excel, Word, and Outlook).
Preferred Qualifications
- Previous experience within Pharmacy Benefit Management (PBM) or pharmaceutical related industry.
- Previous Med D grievance experience.
Education
H.S or Equivalent
Bachelor s Degree Preferred