Financial Analyst, Claims Adjustment

CVS Health in

  • Type: Full Time
position filled
Job Description The Financial Analyst, Claims Adjustment role performs claims reprocessing to reflect the impact of benefit, eligibility, and other updates. This reprocessing is a vital step in the Service Warranty process which begins with the identification of an issue and includes correcting the issue, reprocessing the claims to reflect the change, and finally administering the member communications and other activities that accompany these corrections. This activity touches millions of claims a year and is used to address benefit coding errors, eligibility changes, program features, and client requests. A successful candidate will manage multiple projects in a fast-paced, technically challenging, process-driven environment. They will possess excellent communication and time-management skills. They will enjoy working alongside a dozen other analysts as part of a high performing team, engaging across numerous functional areas. Tasks associated with this position include: · Reprocess claims using Reverse & Resubmit tools that exist within RxClaim · Extract claim and medical data from RxClaim · Use CVS systems, Access, Excel and other tools to perform analyses and complete their tasks · Summarize adjustment information into standard reports that reflect financial impact and details Analysts work closely with Sales, Account Management, IT, Medicare Part D Services, Client Audit, Benefits, and Implementation teams to manage and coordinate the work. Required Qualifications · 2+ years of Professional Analytical experience and Excel exposure/ utilization Preferred Qualifications · PBM Industry and plan design. RxClaim adjudication or benefits knowledge strongly preferred. · Medicare Part D - PBM or claim adjudication knowledge · Proficiency in IBM AS400 · Understanding of SQL or other querying tools · Ability to program using Visual Basic for Applications · Understanding of data sets, tables/files, queries, joins, and other database concepts · Proficiency with Microsoft Excel, vlookup, if statements, and ability to quickly learn new functions. · Strong customer service focus that includes both internal and external customers. · Excellent verbal and written communication skills. · Aggressive pursuit of goals and completion of tasks when dependent on other parties Education Bachelors degree in financial systems, Accounting systems, Business, Information Systems or significant relevant work experience. If no degree, two additional years of experience are required for each year of college not completed. Business Overview It’s a new day in health care. Combining CVS Health and Aetna was a transformative 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. As a CVS Health colleague, you’ll be at the center of it all. We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability. CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT . We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team . Please note that we only accept applications for employment via this site. If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or cvshealthsupport@us.ibm.com . For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

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