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Job Title :
Claims Analyst
Job ID :
747795BR
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Account Management
Description :
Job Description
The Claims Analyst will be responsible for providing research and resolution to support the complex Commercial and Med D Claims process. The Claims Consultant will effectively communicate to internal partners, clients, members, and providers and to solicit additional information when necessary. The Consultant will support process improvements and provide subject matter expertise within Claim Processing to ensure overall regulatory compliance on Commercial and Med D claims processing matters.


Claims Analyst's are also responsible for:


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Working with internal and external parties on “unclean” claims to gather necessary information to allow claims to be processed.
- Supporting Med D specific processes as they relate to DMR claims such as IRE, Payer out of Order, and Priority claims.
- Supporting research and resolution on special projects
- Providing subject matter expertise on claims for the Claim Processing department and internal partners.
- Supporting leadership and trainers on policies and procedures that relate to commercial and Med D claims.


Required Qualifications
1+ years of previous experience in claims, PBM, healthcare and/or Med D and/or analytics experience is required.

Preferred Qualifications
- Experience on one or more Caremark Adjudication platforms (e.g.: ReCap, RxClaim, RxAmerica, and/or
Pharmacare/CUPE platforms) highly preferred.

- Claims processing experience preferred.
- Strong problem solving and research skills required.
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Ability to work independently, identify issues and suggest solutions.
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Ability to multitask and to identify and shift priorities quickly.
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Ability to coordinate with internal and external partners, track data throughout the process, support inquiry research, and push issues through to resolution.
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Good communication skills.
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Working knowledge of Microsoft Word and Excel is required.
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Microsoft Access and Powerpoint skills are preferred

Education
Bachelor's Degree preferred. Will consider an equivalent combination of education and relevant work experience in lieu of degree.


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: https://jobs.cvshealth.com/

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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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