Experienced Claims Analyst – Waste & Abuse Ideator for Enhanced Healthcare Services

Introduction to CVS Health

At CVS Health, we are driven by a singular, clear purpose: to bring our heart to every moment of your health. This purpose guides our commitment to delivering enhanced, human-driven healthcare for a rapidly changing world. Anchored in our brand — with heart at its center — our mission 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, empowering every individual who works at CVS Health to feel enabled by the role they play in transforming our culture and accelerating our ability to grow and deliver solutions to make healthcare more personal, convenient, and affordable.

Job Overview

We are seeking a dedicated and detail-oriented Claims Analyst – Waste & Abuse Ideator to support our Waste and Misuse program within Investigation and Conduct Change. As a key member of our team, you will be responsible for handling a variety of administrative and project management tasks, including daily oversight and management of clinical records inventory, ongoing monitoring and responding to system mailbox entries, and updating project documentation as needed. You will identify and investigate program-specific issues, recognize solutions, and lead the resolution of issues by collaborating with internal colleagues, external vendors, and suppliers.

Key Responsibilities

• Understand key business drivers for own area of responsibility
• Communicate effectively with internal and external stakeholders
• Clarify product vision and strategy for stakeholders within A&BC, seeing how product aligns with CVSH
• Identify suitable data sources for analysis solutions
• Conduct daily monitoring of clinical record inventory to claim outcome
• Work directly with key junior partners
• Analyze an issue or complaint, plan a solution, and craft a response
• Make independent decisions
• Assist with maintenance of overall program documentation
• Drive engagement with colleagues
• Seek solutions to issues by collaborating with others
• Collaborate with Program Supervisor to plan and prioritize
• Develop processes for assessing prioritization of issues and goals
• Organize clear, concise messaging that accurately reflects the data with direction

Essential Qualifications

To be successful in this role, you will need:

• 3-5 years of industry experience with healthcare claims, claim processing, and claim platforms
• 3+ years in claims processing data and experience within ACAS, QNXT, or HRP (HRP strongly preferred)
• Proficiency in QuickBase
• Ability to work independently
• Strong analytical and research skills
• Ability to navigate and identify data resources
• Conscientious and detail-oriented
• Strong verbal and written communication skills

Preferred Qualifications

While not required, the following qualifications are preferred:

• Ability to connect with various groups at different levels
• Ability to use 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 data to different audiences
• Proficiency in Word, Excel, database search tools, and the use of the Intranet/Web to navigate data

Education

A Bachelor's degree is preferred, or three years of equivalent experience in the healthcare industry.

Compensation and Benefits

The salary range for this position is $70-$80 per year. This 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 various 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 salary range listed above.

In addition to your salary, you will enjoy the benefits of an organization that puts its heart into caring for its employees and 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 for eligible employees, as well as short-term and long-term disability benefits. CVS Health also offers various wellness programs, education assistance, free development courses, a CVS store discount, and partner discount programs. Regarding downtime, company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year.

Work Environment and Company Culture

At CVS Health, we are committed to creating a work environment that is inclusive, supportive, and empowering. Our company culture values diversity, equity, and inclusion, and we strive to create a workplace where everyone feels valued, respected, and able to contribute their best work. We offer a range of programs and resources to support our employees' physical, emotional, and financial well-being, including employee resource groups, mental health resources, and financial wellness tools.

How to Apply

To apply for this exciting opportunity, please follow these steps:

• Read the official notification carefully from the official website
• Fill out the application form (the link is given below)
• Attach the required documents and passport-size photo with signature
• Then submit

Required Documents

The following documents are required for this recruitment:

• Qualifications certificate with mark sheets
• Passport-size photographs
• Signature

Conclusion

If you are a motivated and detail-oriented individual with a passion for healthcare and a commitment to excellence, we encourage you to apply for this exciting opportunity. As a Claims Analyst – Waste & Abuse Ideator at CVS Health, you will have the chance to make a real difference in the lives of our patients and customers, while also growing your career and developing your skills in a dynamic and supportive environment. Don't miss out on this opportunity to join our team and help us bring our heart to every moment of healthcare.