At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
Manages day-to-day of team by providing strategic leadership and overseeing the operations of the claims processing team(s). Directs workflow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics, managing and developing a team of claims support individuals, implementing process improvement initiatives, and fostering collaboration with internal and external stakeholders to optimize claim processing, minimize errors, and enhance overall operational effectiveness and customer satisfaction.
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What you will doEnsures the efficient and timely processing of claims by effectively managing the workflow processing and completion within the department.
Implements and maintains quality control processes to ensure accuracy and consistency in claim processing.
Advises team members in resolving complex or escalated claims issues by providing guidance on claim handling procedures, policy interpretation, and compliance with industry regulations.
Analyzes key performance indicators (KPIs) to assess the productivity and quality of the claims department and prepares regular performance reports for management.
Streamlines and improves claim processing procedures by collaborating with cross-functional teams to implement process enhancements, automation, and system upgrades to increase efficiency and accuracy.
Ensures consistent compliance with applicable laws, regulations, and industry standards related to claims processing.
Assists management in the development of the department's budget by monitoring expenses, analyzing budget variances, and recommending cost-saving measures while ensuring operational effectiveness and maintaining service quality.
Establishes a positive work environment, encouraging professional development, and addressing any performance issues.
Directs tasks and responsibilities to team members, ensuring the claim workload distribution is equitable and efficient.Required Qualifications
- 3- 5 leadership/management experience
- Must be proficient in Word, Excel, and Microsoft Office
- Ability to collaborate and work as a team
- Ability to execute a plan and deliver (planning, delivering, and supporting)
- Ability to solve problems and make sound business decisions
- Adept at growth mindset (agility and developing yourself and mentor others)
- 3-5 years insurance claims processing experience
- Bachelor's degree preferred or a combination of professional work experience and education.
40Time Type
Full timePay Range
The typical pay range for this role is:$54,300.00 - $159,120.00This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.