Experienced Claims Analyst for Waste & Abuse Program - Data Entry and Project Management Role

Join CVS Health and Make a Difference in Healthcare

At CVS Health, we're driven by a singular purpose: to bring our heart to every moment of your health. Our commitment to delivering enhanced, human-driven healthcare is at the forefront of everything we do. As a leading healthcare organization, we're dedicated to making healthcare more personal, convenient, and affordable. If you're passionate about making a difference in the healthcare industry, we invite you to explore this exciting opportunity to join our team as a Claims Analyst for our Waste & Abuse program.

About the Role

The Claims Analyst will play a critical role in supporting the Waste and Abuse program within Investigation and Conduct Change. This position will be responsible for managing a variety of administrative and project management tasks, including daily oversight and management of clinical records inventory, ongoing monitoring and response to system post box entries, and updating project documentation as needed. The ideal candidate will be able to work independently and collaboratively with the program team to identify and investigate program-specific issues, develop solutions, and drive resolution.

Key Responsibilities:

• Understand key business drivers for own area of responsibility and align with CVS Health's overall strategy
• Communicate effectively with internal and external stakeholders to drive program goals and objectives
• Analyze data and identify insights to inform program decisions and drive business outcomes
• Manage daily clinical records inventory to ensure timely and accurate processing
• Collaborate with Program Administrator, Decision Researcher, and other stakeholders to achieve operational and financial targets
• Develop and implement processes to evaluate prioritization of issues and goals
• Create clear, concise messaging that accurately reflects data insights and recommendations
• Work independently and as part of a team to drive program success

Essential Qualifications

To be considered for this role, you must have:

• 3-5 years of industry experience with healthcare claims, claim processing, and claim adjudication
• 3+ years of experience in claims handling and data analysis within ACAS, QNXT, or HRP (HRP strongly preferred)
• Proficiency in QuickBase and ability to work independently
• Strong analytical and research skills, with the ability to identify data sources and insights
• Excellent verbal and written communication skills, with the ability to present data insights to various audiences

Preferred Qualifications

To stand out as a candidate, you should have:

• Ability to connect with various groups at different levels and build effective relationships
• Knowledge of Aetna's policies and procedures (or similar experience)
• Proficiency in Word, Excel, Database search tools, and Intranet/Web navigation
• Strong written and verbal communication skills, with the ability to present data insights to various audiences
• Bachelor's degree or equivalent experience in the healthcare industry (preferred)

What We Offer

At CVS Health, we offer a comprehensive benefits package that includes:

• Competitive salary and bonus structure
• Medical, dental, and vision benefits
• 401(k) retirement savings plan and Employee Stock Purchase Plan
• Life insurance and disability benefits
• Wellness programs and employee assistance programs
• Paid time off and holidays
• Opportunities for career growth and development

Our Culture

At CVS Health, we're committed to creating a culture that values diversity, equity, and inclusion. We believe in fostering a work environment that is inclusive, supportive, and empowering. Our Heart At Work Behaviors guide our actions and decisions, and we're dedicated to making a positive impact in the communities we serve.

Why Join CVS Health?

By joining CVS Health, you'll become part of a team that is passionate about making a difference in healthcare. You'll have the opportunity to work on exciting projects, develop your skills, and grow your career. Our commitment to innovation, customer-centricity, and community engagement makes us a unique and rewarding place to work.

How to Apply

If you're ready to join a team that is making a difference in healthcare, please submit your application, including your resume and cover letter, through our online application portal. We can't wait to hear from you!

Apply Now!

Equal Employment Opportunity

CVS Health is an equal employment opportunity employer and is committed to diversity, equity, and inclusion. We welcome applications from qualified candidates of all backgrounds.

COVID-19 Vaccination Policy

CVS Health requires certain associates to be fully vaccinated against COVID-19, where applicable under the law, unless they are approved for a reasonable accommodation based on disability, illness, religious belief, or other legally recognized reasons.

By applying for this role, you acknowledge that you have read and understood our COVID-19 vaccination policy and are willing to comply with its requirements.