About the job
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.
Position Summary
Performs claims documentation review for Medicare Supplement claims, particularly those that follow Medicare as a secondary payer. Verifies opportunities for fraud, waste, and abuse detection. Collaborates with internal teams to streamline data integrity and compliance.
- Performs in-depth data analysis to detect patterns or anomalies indicative of potential fraud, waste, and abuse (FWA), especially in secondary claim submissions.
- Escalates suspicious billing behavior or inconsistent patterns to management or the Special Investigations Unit (SIU), providing supporting documentation and analysis.
- Identifies system and process improvements in workflows to enhance accuracy, timeliness, and fraud prevention.
Communicates via telephone with providers and members to investigate possible fraud.
Required Qualifications
- 1+ years of experience in claims processing or data analysis, including Medicare Supplement claims
- Strong problem-solving and decision-making skills
- Strong Customer Service skills
Preferred Qualifications
Proficiency in analyzing claims data and reporting tools (Excel, SQL, Tableau, etc.)
Education
High school diploma or equivalent required
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The Typical Pay Range For This Role Is
$18.50 - $35.29
This 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 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 05/20/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
No comments:
Post a Comment