Claim Data Specialist OPS, Claim Lifeline
Apply Here Job Description :
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
We are looking for a highly motivated candidate who can work across teams to provide claim subject matter expertise. The Claim Lifeline Specialist will respond to Lifeline inquiries and handle real time member rework. The candidate selected should be able to effectively collaborate with Member Services and serve as a claim expert and will rework claims real time to expand our current service model.
The candidate will be responsible to staff the Claim Lifeline, respond to claim inquiries from the Member Services team and rework claims when appropriate. They will be responsible to provide education when appropriate and watch for trends to help mitigate the risk of ongoing rework. The Claim Lifeline will be open and staffed from 8:00am – 9:00pm ET. Can sit anywhere in the U.S.
Required Qualifications
- 1+ years Medical or Hospital ACAS claim processing experience is required.
- Knowledge of EPDB, SCM Inquiry & Plan Systems is preferred.
- Ability to analyze claims, identify root causes and solve problems quickly.
- Excellent oral and written communication skills.
- Self-driven and ability to manage multiple priorities.
- Be efficient and flexible to meet organizational goals.
- 1+ years experience with all Aetna Standard Plans
Preferred Qualifications
- Technical – Aetna Applications – Enterprise Provider Database System/1-3 Years/End User
- Technical – Aetna Applications – Strategic Contracts Manager/1-3 Years/End User
- Technical – Desktop Tools – Microsoft Foundation Classes/1-3 Years/End User
- Creating a Differentiated Service Experience
- Driving a Culture of Compliance
- Providing Solutions to Constituent Needs
Education
- High School diploma, G.E.D. or equivalent experience
Pay Range
The typical pay range for this role is:
$18.50 – $35.29
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.
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
