The Financial Analyst, Claims Adjustment role performs claims reverse and reprocessing (R&R) to address benefit coding errors, eligibility changes, program features, and client requests. This reprocessing is a vital step in the Adjustment or Service Warranty process. This entails resolving rejects and QA fails, obtaining multiple levels of approvals, and closing out the cases in a timely manner to issue financial impacts to members, clients, and pharmacies. This activity touches millions of claims a year and has wide organizational impacts.
This role is required to manage an individual queue of multiple projects in a fast-paced, process-driven environment. Attention to detail, excellent communication, and time-management skills are essential.
Analysts work closely with multiple internal departments such as Sales, Account Management, IT, Medicare Part D Services, Client Audit, Benefits, and Implementations to manage and coordinate the work.
The typical pay range for this role is:
Please 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.
-- 1+ years of financial and/or healthcare experience
-- 1+ years of analytical experience with large data sets
-- 2+ years of Microsoft Excel specially vlookup, pivot tables, and creating graphs
COVID-19 Vaccination Requirement
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.
- PBM Industry and plan design. RxClaim adjudication or benefits knowledge.
- Medicare Part D - PBM or claim adjudication knowledge.
- Understanding of data sets, tables/files, queries, joins, and other database concepts.
- Strong customer service focus that includes both internal and external customers.
- Excellent verbal and written communication skills.
- Highly desired Excel skills include ability to manage and present large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.
-- Detail oriented
-- 1+ years of healthcare experience
-- Verifiable Bachelors degree or equivalent experience required.
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.
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.