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.

It’s a new day in healthcare!Combining CVS Health and Aetna was a ground-breaking moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health.In the past 4 years our membership has doubled and our market share has grown 50%; you will help us take all this to the next level, using your industry knowledge, passion for problem solving and quantitative analysis, and skills in communication and client management to identify, incubate, and deploy the next set of innovations to power the growth of tomorrow’s business!

Job Summary:

P osition dedicated to supporting the Payment Accuracy Self Insured program within Analytics & Behavior Change. This resource will be asked to develop concepts to create inventory for the team, project management actions within this program, including daily oversight and management of new ideas, concepts for where the system has breaks and when providers send in errant payments. 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, Data 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.

• Researches e-policy and payment processing guidelines.

• Works directly with key junior stakeholders.

• Ability to analyze issues, strategize solutions, and craft responses or action(s).

• Ability to make decisions independently.

• Assists with maintenance of overarching program documentation.

• Drives engagement with business partners.

• Ability to seek a solution for issues by collaborating with others.

• Collaborates with Program Manager to prioritize and solve issues.

• Develops processes of evaluating prioritization of issues and resolutions.

• Writes clear, concise messaging that accurately reflects the data with guidance.

Minimum Requirements:

• Minimum of three plus years industry experience with health care claims, claim processing, and claim platforms

• Ability to write business requirements documents

• 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

• 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

• 3+ years in claims processing knowledge and experience within ACAS, QNXT or HRP (ACAS strongly preferred)

• Ability to analyze large data sets with complex pivots, filters and

• 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 industry

Pay Range

The typical pay range for this role is:

$72,100.00 - $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

We anticipate the application window for this opening will close on: 05/20/2024

We are an equal opportunity and affirmative action employer. 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.