We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Informatics Manager designs and executes claim operational analysis, creating insight into the Medical and Dental claim operational environments for Aetna actuaries, Service Operations Leadership, Compliance, Market leads and production teams. The Consultant evaluates the operational and financial flow of claims throughout the claim lifecycle, across multiple claim systems, and includes both a) monitoring normal flow and b) identifying and quantifying topics of concern. The position also builds information resources to support tactical operational needs, fulfills requests for operational data, and performs a variety of analysis to support Service Operations' needs. As a member of our Claim Operations Analytics team, you'll have the opportunity to learn as you provide valuable information to decision-makers.
Required Qualifications:
- 3+ years’ experience using SAS, BigQuery, SQL, Python, or similar query language, to extract, transform, process, and summarize large datasets
- 2+ years performing large scale analysis on medical claim operational (i.e., non-clinical) data. Examples such as auto-adjudication rates, turnaround times, payment patterns, inventory composition, denial rates, etc.
- Demonstrated business knowledge of the medical claim lifecycle (Claim Intake, Adjudication, Editing, Pend/Inventory management, Payment, Appeals, Rework)
- Demonstrated ability to manage multiple projects simultaneously
- Experience performing data 'quality and reasonableness' testing on claim operational data
- Strong Excel skills, including mastery of logical & text functions, pivot tables
- Experience applying logic and critical thinking to solve business problems involving operational data
- Experience turning data into information
- Excellent written communication skills
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$66,330.00 - $145,860.00This 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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Top Skills
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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