Grievance Analyst (Pending Case Review)

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 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 returned to the grievance caseworker for review and correction. 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 the Grievance team. Lastly, this position will also include providing support to various operational teams within the Grievance department, as needed. This may include working grievance cases, initial quality review, 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. The Analyst will also need intermediate to advanced knowledge of various Caremark systems including MedHOK, PeopleSafe, the Source and RxClaim, and be able to navigate between systems throughout the review process. Previous Med D grievance experience and knowledge of grievance processes is required. Required Qualifications - 2 plus 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). - A minimum of 2 years Med D grievance experience and advanced knowledge of grievance processes. Preferred Qualifications - Previous experience within Pharmacy Benefit Management (PBM) or pharmaceutical related industry. - Previous experience with working Pending Case Review (PCR). - Bachelor's Degree Preferred Education High School Diploma or equivalent GED Pay Range The typical pay range for this role is: $43,888.00 - $76,500.00 This 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | CVS Health We anticipate the application window for this opening will close on: 10/25/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area

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