Claims Analyst - Waste & Abuse Ideator

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
Position dedicated to supporting the Waste & Abuse program within Analytics & Behavior Change. This resource will be asked to handle a variety of administrative and project management tasks within this program, including daily oversight and management of medical records inventory, ongoing monitoring and responding to program mailbox entries, and updating project documentation as needed. Identifies and researches program-specific issues, identifies solutions and leads resolution of issues working with internal business partners, external vendors, and providers.
Collaborates with Program Manager, Decision Scientist and various other stakeholders to achieve operational and financial objectives. Needs to be able to work well independently and also work collaboratively with the program team.
Lead Responsibilities:

• Understands key business drivers for own area of responsibility.
• Ability to communicate effectively with internal and external stakeholders.
• Can explain product vision and strategy to colleagues within A&BC, understands fully how product aligns with CVSH.

• Identifies appropriate data sources for analytics solutions.
• Conduct daily monitoring of medical record inventory to decision outcome.
• Works directly with key junior stakeholders.
• Ability to analyze an issue or complaint, strategize solution, and craft response
• Ability to make decisions independently.
• Assist with maintenance of overarching program documentation.
• Drive engagement with business partners.
• Ability to seek a solution for issues by collaborating with others.
• Will interact with Program Manager to solution and prioritize.
• Develops processes of evaluating prioritization of issues and resolutions.
• Writes clear, concise messaging that accurately reflect the data with guidance.

Required Qualifications

• 3-5 years of industry experience with health care claims, claim processing, and claim platforms
• 3+ years in claims processing knowledge and experience within ACAS, QNXT or HRP (HRP strongly preferred).
• Proficient in QuickBase
• Ability to work independently
• Strong analytical and research skills
• Proficient in researching information and identifying information resources
• Detail-oriented
• Strong verbal and written communication skills

Preferred Qualifications

• Ability to interact with different groups of people at different levels
• Ability to utilize company systems to obtain relevant electronic documentation
• Knowledge of Aetna's policies and procedures
• Demonstrated written and verbal communication skills with the ability to present information to various audiences.
• Proficiency in Word, Excel, Database search tools, and the use of the Intranet/Internet to research information.

Education

• Preferred Bachelor's degree or three years of equivalent experience in the health care industry

Pay Range
The typical pay range for this role is:
$75,705.00 - $154,500.00
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 jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.