We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary:
We are looking for a highly motivated candidate who can effectively and accurately oversee and coordinate rework projects, work closely with other members of the Commercial Services Operations team providing project management, root cause analysis and precise resolution of affected claims. The candidate is responsible for ensuring the project stays on track, is resolved accurately, interfaces with appropriate areas and is handled by the due date.
The candidate will serve as a Project Lead for rework projects/issues for a specific network or large-scale rework projects generated as a result of Plan Sponsor issues, release fallout and/or legal/regulatory/compliance concerns. Projects may be national in scope, specific to a particular health network or state, and/or systemic in nature.
Required Qualifications:
The candidate MUST HAVE knowledge of Aetna claim and provider systems and will be responsible for regular project discussion/updates via conference calls. This candidate should demonstrate a strong work ethic. Being efficient and flexible is essential to the position in order to meet critical turnaround objectives.
Minimum Requirements
- 2+ years experience processing claims through the ACAS system.
- Ability to work independently as well as part of the team; contributing to overall effectiveness of the team.
- Ability to analyze data.
- Able to successfully cope with the high demands of the job while effectively maintaining personal composure.
- Initiative to improve personal performance as well as those of peers and team.
Preferred Qualifications
- We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
- Aetna Service Operations office/hub locations will be discussed with the selected candidate.
- USQA reporting, Excel, Word and ACCESS would be a plus.
Education:
- High School diploma, G.E.D. or equivalent experience.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $112,200.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
