Senior Claims Research Coordinator

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🔥 1 hour ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $47k - $122.4k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Conduct comprehensive research and data analysis, ensuring the highest level of data quality and insightful reporting on claim drivers/outcomes • Utilize advanced understanding of medical claims processing, leveraging this knowledge to support and innovate within the claims analysis function • Establish and maintain a strategic consultative relationship with both internal teams and external clients • Offer authoritative oversight and feedback on data quality, directly contributing to service improvement and design advancement • Execute dedicated research and root cause analysis to pinpoint issues within the claims process and recommend evidence-based solutions • Perform other duties as needed.

🎯 Requirements

• 2+ years of experience with claims processing, including a demonstrated familiarity with automated medical claims payment systems and/or payer systems (i.e. Facets, QNXT, etc.) • 2+ years of experience in data interpretation and analysis, including utilizing SQL to pull and manipulate large data sets • Willingness to work Monday-Friday from 8am-5pm CST • Willingness to travel up to 10% of the time within the continental United States • Previous experience with state Medicaid, particularly in Illinois • Superlative communication abilities, encompassing both verbal and written formats • Proven track record of configuration experience within a claims system environment • In-depth research abilities and significant experience in conducting root cause analysis in claims or related fields • An aptitude for working independently, as well as part of a team, with a keen eye for detail and problem-solving • Knowledge and experience with SQL-type programs for the purpose of pulling specific claim files and validating accuracy.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility