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
- Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries.
- Determine whether any claim payment or denial issues are present, particularly those that may affect utilization management, enrollment, claims, configuration, network, contracting and/or provider data.
- Submit the necessary documents (if issues are identified) to specific areas, in an effort to ensure all is updated and corrected.
- Submit all projects and/or claims to be reprocessed, in order to ensure provider contracts are implemented effectively, as well as to avoid any further ongoing issues.
- Perform education for providers, both internal and external, when required.
- Attend provider group meetings, as well as individual meetings, both internally and externally.
- Submit projects within Microsoft Excel as assigned.
- Perform other duties as needed.
Required Qualifications
- 1-3 years of medical claims experience.
- 1-3 years of intermediate Excel experience, with demonstrated proficiency in formulas, pivot tables, and vlookups.
- Must reside in Florida.
Preferred Qualifications
- Bilingual in English/Spanish.
- 2+ years of provider claims experience.
- Certified Professional Coder (CPC).
- Knowledge of provider billing, particularly with professional and hospital claims.
- Strong attention to detail.
- Excellent communication, collaboration, and relationship building skills.
- Self-motivated and ability to drive independent work.
- Strong writing and documentation skills.
Education
- High school diploma or GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $35.29This 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.
Skills Required
- 1-3 years of medical claims experience
- 1-3 years intermediate Microsoft Excel experience (formulas, pivot tables, VLOOKUPs)
- Must reside in Florida
- High school diploma or GED
- Bilingual in English/Spanish
- 2+ years of provider claims experience
- Certified Professional Coder (CPC)
- Knowledge of provider billing (professional and hospital claims)
- Strong attention to detail
- Excellent communication, collaboration, and relationship building skills
- Self-motivated with ability to drive independent work
- Strong writing and documentation 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.
