Senior Analyst Claim Reporting and Special Services

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

• Knowledge of Aetna claim and provider systems
• Regular project discussion/updates via conference calls
• A strong work ethic
• Efficient and flexible to meet critical turnaround objectives
• 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

• USQA reporting, Excel, Word and ACCESS

Education

High School diploma, G.E.D. or equivalent experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $46,988.00 - $112,200.00

This 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.