Senior Claims Analyst, Financial Operations

2 weeks ago

Northbrook, Illinois, United States CVS Health Full time
Company Overview
At CVS Health, we are dedicated to enhancing health care through a human-centric approach. Our mission is to ensure that every interaction reflects our commitment to improving health outcomes for our communities.

Position Overview
The Senior Analyst position is crucial in diagnosing claims to pinpoint those affected by modifications in plan benefits. This diagnosis is a key component of the Service Warranty process, initiating with a thorough examination of the issue parameters followed by executing AS400 queries to identify the claims in question.

Daily responsibilities may include:
  • Extracting affected claims for conversion and submission for review and resolution.
  • Conducting detailed manual analyses in Excel for impacted claims.

This role plays a significant part in identifying financial repercussions for clients, members, and pharmacies stemming from errors in benefit coding, eligibility alterations, program features, and client inquiries.

Key Responsibilities
The Senior Analyst will manage a personal queue of various projects within a dynamic, process-oriented environment. Strong communication and time-management skills are essential, as the findings may need to be presented to both internal and external stakeholders.

Expectations include:
  • Handling complex submissions as well as grouped submissions regardless of their complexity.
  • Contributing to team responsibilities beyond the Service Warranty queue, such as training, reporting, documentation, and collaboration on ad-hoc projects.

Collaboration
This role requires close cooperation with various teams, including Sales, Account Management, Client Audit, Benefits, Clinical, and Rebates, to effectively manage and coordinate tasks.

Qualifications
Required:
  • Minimum of 2 years of experience in the healthcare sector.
  • At least 2 years of proficiency in Excel, including the ability to manage and present extensive data sets, utilize complex formulas, format reports, create pivot tables, and manipulate data effectively.

Preferred:
  • In-depth understanding of data structures, tables, queries, joins, and other database concepts.
  • Strong focus on customer service for both internal and external clients.
  • Exceptional verbal and written communication skills.
  • Experience in the PBM industry and knowledge of plan design, particularly with RxClaim adjudication or benefits.
  • Familiarity with CVS Caremark PBM adjudication/systems, LINKS/Mail order, AS400/mainframe, or similar experience is highly desirable.
  • Experience in business operations with a focus on high-volume transactions.
  • Advanced Excel skills, including managing large data sets and utilizing complex functions.

Education
A Bachelor's Degree or equivalent professional experience is required.

Compensation and Benefits
The typical pay range for this role is between $46,000 and $112,200 annually. This range represents the base salary for all positions within the job grade associated with this role. Actual salary offers will vary based on factors such as experience, education, and location.

In addition to competitive compensation, CVS Health offers a comprehensive benefits package, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan for eligible employees. Additional benefits include fully-paid term life insurance, short-term and long-term disability coverage, and various well-being programs. Employees also enjoy Paid Time Off (PTO), vacation pay, and paid holidays throughout the year.

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