Sr Analyst Plan Sponsor- Hybrid Remote in Hartford, CT

Job DescriptionThe Medicare Client Service team is looking for a mature professional with experience in working within a complex and fast paced organization. The Plan Sponsor Liaison will work onsite at the customer's location in Hartford, Connecticut 2-3 days per week. Also, we are looking for an individual who has the ability to perform root cause research and analysis to manage multiple inquires and recommended solutions. Candidates will be required to lead change, use strategic thinking, and collaborate with other departments to ensure all issues are resolved. Candidates must be able to provide examples of public speaking, prior analysis, root cause determination and recommended outcomes. Also, candidates should have strong customer service skills to coordinate concierge service delivery and member advocacy including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members. Plan Sponsor Liaison for plan sponsors on member specific or broader plan administration matters Understands life cycle view of Medicare activities, quotes, install, eligibility, billing, administration, benefits, provider/network activity, claims (medical & RX), etc. Develops/implements a customer service strategy for each assigned Plan Sponsors/TPA's (customer fact sheets) Participates in implementation calls and site visits on plan sponsor's book of business serving as the Medicare Advantage subject matter expert (travel as needed) Identifies business problems, obtains information and accurately defines root causes while developing a course of action for successful service solutions Initiates and maintains partnerships with others within Aetna to encourage cooperation and cross-functional activities on workflow, ideas and service solutions Ownership and accountability for the resolution of the Plan Sponsors/TPA service inquires. Ownership of the Plan Sponsor Tool, ID card quality review, Archer as well as use service tools to provide detailed membership reporting to create a snapshot of the lifecycle. Work in tandem to monitor the submission of new business & renewal paperwork to ensure systems are updated & eligibility is processed in accordance to Open Enrollment timeline Provide updates on issue resolution and action plans to Plan Sponsor, TPA, Sales Executives and Medicare Client Services management Acknowledge receipt of escalated service inquiries to the plan sponsors/account team and resolve/respond in less than 1 business day, and for issues requiring a longer resolution, follow up at set intervals Takes a proactive role in all internal/external calls by being prepared and well versed in all subject matters related to PSL role & responsibility. PSL leads all back-office operation conversations, researches and responds to all operational takeaways. Articulates the CMS regulatory requirements that govern the Aetna Medicare Advantage Plans and demonstrate knowledge of understanding of all Aetna Medicare products and services.Pay RangeThe typical pay range for this role is:Minimum: 43,700Maximum: 100,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications Customer Service - Plan Sponsor - Eligibility - HMO/1-3 Years Communications - Communication Delivery - Public Speaking/1-3 Years Claims - Medical Claim processing- Medicare/1-3 YearsPreferred QualificationsCandidate should have a strong knowledge of Original Medicare guidelines/requirements & Aetna Medicare Advantage policies. The Plan Sponsor Liaison will be responsible for managing and maintaining their own book of business as candidates must be detailed oriented.General Business/Turning Data into Information/ADVANCEDService/Creating a Differentiated Service Experience/FOUNDATIONService/Working Across Boundaries/ADVANCEDEducationBachelor's degree or equivalent experienceBusiness OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2024-11-02