We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Develops and executes comprehensive testing processes for system enhancements and new products and processes encompassing all aspects of customer service including claims, enrollment, provider contracts, and benefits administration.
Responsible for creating and executing defined unit testing processes to provide quality audits for vendor contracts prior to implementation.
Assists with testing simple system enhancements.
Prepares and executes a comprehensive test plan and test scripts to provide quality audits for vendor contracts to ensure quality and accuracy is maintained.
Verifies that system functions according to user requirements and conforms to established guidelines.
Follows standardized best practices for documenting and executing simple to moderately complex test plans.
Validates test results, documents discrepancies, and follows through with resolutions to ensure all issues are resolved.
Reports progress of problem resolution to management.
Communicates test outcomes to end users for sign-off on the results.
Serves as liaison between the system end users and the IT team.
Performs other duties as required.
This position is part of Service Operations
Required Qualifications
2+ years related experience in a service center medical claims (not RX claims) processing or managed care operational role.
1 year recent and related system processing, payment, and benefits experience, preferably IDX managed care.
Broad knowledge of medical terminology, claims, customary and reasonable cost containment, coordination of benefits, diagnosis coding, and general customer services sources.
Excellent verbal and written communication skills
Preferred Qualifications
- QNXT managed care
Education
High School Diploma or GED
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $25.65This 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 2+ years of related experience in service center medical claims processing or managed care operations
- 1 year of recent related experience with system processing, payments, and benefits
- Knowledge of medical terminology, claims, customary and reasonable cost containment, coordination of benefits, diagnosis coding, and customer service
- Excellent verbal and written communication skills
- High school diploma or GED
- Experience with QNXT managed care
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage is described as broad and robust, spanning medical, dental, vision, prescription, life, and disability insurance. Access to no-cost preventive care through MinuteClinic and virtual medical services further enhances the package.
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Wellbeing & Lifestyle Benefits — Wellness and education resources stand out, including tuition assistance, confidential counseling with generous session limits, virtual mental-health care, fitness programs, financial coaching, and employee discounts. Backup-care support and other lifestyle discounts add everyday value.
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Parental & Family Support — Family-oriented programs such as paid parental leave, adoption and surrogacy assistance, doula support, caregiving resources, and backup care are highlighted. These offerings indicate meaningful support for different life stages.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
