Claim Reprocessing Senior Associate
Location:
Cumberland , Rhode Island
Posted:
November 23, 2017
Reference:
719714BR
Position Summary:
As a Claim Reprocessing Associate, you will be responsible for the timely and accurate reprocessing of pharmacy claims that require editing from corporate. In this role, you will perform work through our RX connect system on claims to identify trends and issues, propose and facilitate proper handling, and recommend solutions to prevent future occurrences. These tasks include outreach to pharmacies to notify them of any edits and other internal areas to ascertain the necessary information to correct and reprocess the claim. The Claims Reprocessing Associate is also responsible for evaluating the effectiveness of claim reprocessing procedures for timeliness and accuracy and will identify opportunities, and recommend/implement process improvements.

Required Qualifications:
- 1+ years professional experience, preferably in a retail pharmacy or pharmacy call center setting
- 1+ years using Excel in a professional or academic setting


Preferred Qualifications:
- Ability to make process improvement suggestions consistently
- Ability to handle multiple competing high priority tasks and projects simultaneously
- Ability to make recommendations to reduce bad debt
- Ability to complete routinely assigned work based on productivity standards (SLA) with minimal supervision
- Basic working knowledge of all MS Operating Systems and MS Office applications (such as MS Word, Excel, Access, and Outlook)

- Flexibility to adapt to a changing environment, quickly making sound decisions and the desire to seek continued professional growth
- Ability to work individually and/or with a team to systematically identify root cause, define problems, evaluate alternatives and recommend/implement viable solutions
- Excellent verbal and written communication skills and the ability to interact professionally with internal/external business partners (i.e. directors, managers, colleagues and external entities)

- Prior Pharmacy Experience



Education:
Verifiable High School Diploma or GED is Required. Bachelor Degree is preferred in Accounting, Finance, or Business.

Business Overview:
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/

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