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Job Title :
Claims Quality Coordinator
Job ID :
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Description :
Job Description
As a Claims Quality Coordinator, you will be responsible for reviewing all components of member submissions for paper
claims. This Quality Coordinator role is essential to ensuring that all claims are properly processed to ensure the correct parties are billed/reimbursed appropriately and in a timely manner. You will review submitted member data in a workflow system against adjudicated claim data to ensure that all claims have been properly entered.

Additionally, the Quality Coordinator will:
- Perform data mining to review, the accuracy of member/provider payments
- Adhere to specified TAT (Turn Around Time) as defined by the business need
- Maintain a high level of self-learning to be up to date on the current documented processes, standard operating procedures (SOP), and regulatory guidelines

Required Qualifications
- 2+ years of experience in pharmacy/Medicare Part D claims processing and/or audit

Preferred Qualifications
- Medicare Part D or related industry knowledge
- Exposure to CMS reimbursement request forms
- Analytical thinking and rational decision making skills
- Experience in claims adjudication
- General Quality Assurance
- Proficiency in MS Word and MS Excel
- Strong written and verbal communication skills is essential, including the ability to effectively present information and respond to questions from groups of associates, managers and clients
- Strong interpersonal skills with the ability to collaborate in teams across geographically diverse settings
- Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form
- Ability to maintain a high level of consistency while working with team members
- Demonstrate a clear understanding of company and client confidentiality
- Excellent organizational skills
Adaptable and able to move with change while maintaining a positive attitude

High School required
Bachelors preferred

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, 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

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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Our culture

CVS Health core values of Innovation, Collaboration, Caring, Integrity, and Accountability not only support our purpose of helping people on their path to better health for our customers and patients, but they also apply to how we support our more than 250,000 colleagues. You will find our culture at CVS Health, and our leaders encourage personal and professional growth.

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