Med D Financial Operations Analyst, Claims Adjustment
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.The MED D Financial Analyst, Claims Adjustment role performs claims reverse and reprocessing (R&R) to address benefit coding errors, eligibility changes, program features, and client requests. This reprocessing is a vital step in the Adjustment process. This entails resolving rejects and QA fails, obtaining multiple levels of approvals, and closing out the cases in a timely manner to issue financial impacts to members, clients, and pharmacies. This activity touches millions of claims a year and has wide organizational impacts.
This role is required to manage an individual queue of multiple projects in a fast-paced, process-driven environment. Attention to detail, excellent communication, and time-management skills are essential.
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Analysts work closely with multiple internal departments such as Sales, Account Management, IT, Medicare Part D Services, Client Audit, Benefits, and Implementations to manage and coordinate the work.Required Qualifications:
- 1+ years of financial or healthcare experience
- 1+ years of utilizing advanced Excel skillsPreferred Qualifications:
- PBM Industry and plan design.
- RxClaim adjudication or benefits knowledge.
- Medicare Part D - PBM or claim adjudication knowledge.
- Proficiency in IBM AS400.
- Understanding of data sets, tables/files, queries, joins, and other database concepts.
- Highly desired Excel skills include ability to manage and present large volumes of data, creating/using complex formulas, report formatting, pivot tables, data manipulation, and other advanced functions.
- Strong customer service focus that includes both internal and external customers.
- Excellent verbal and written communication skills.Education:
- Verifiable Bachelor's degree or equivalent experience required Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$43,888.00 - $93,574.00This 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.
Perks and Benefits
Health and Wellness
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- HSA
- HSA With Employer Contribution
- Pet Insurance
- Mental Health Benefits
Parental Benefits
- Fertility Benefits
- Adoption Assistance Program
- Family Support Resources
Work Flexibility
- Flexible Work Hours
- Remote Work Opportunities
- Hybrid Work Opportunities
Office Life and Perks
Vacation and Time Off
- Paid Vacation
- Paid Holidays
- Personal/Sick Days
Financial and Retirement
- 401(K) With Company Matching
Professional Development
- Tuition Reimbursement
Diversity and Inclusion
- Employee Resource Groups (ERG)
- Diversity, Equity, and Inclusion Program