Job DescriptionAs a Quality Assurance Analyst, you will be responsible for providing technical and analytical support for Medicare Part D (Med D) claims monitoring. In this position, you will have the opportunity to focus on moderate to complex claim reviews of financial attributes and/or clinical programs. You will sit as a member on a diverse team that ensures Med D claims are processed appropriately and within CMS guidelines.
Other responsibilities in the role include:
- Using root cause analysis skills to identify claim adjudication issues and determine a resolution
- Forwarding detected adjudication discrepancies to the appropriate business area for resolution
- Supporting external audit research activities
- Reviewing, interpreting, and fully understand CMS guidelines related to claim adjudication
- 1+ years of experience with Microsoft Office, including Excel and Access
- 1 + years of healthcare or PBM experience
- Previous Med D experience
- RxClaim/AS400 proficiency
- Demonstrated analytical skills and attention to detail
- Ability to effectively define issues, collect data, establish facts, and draw valid conclusions
- Knowledge of claim adjudication and benefit plan design
- Proficient in analyzing specific types of claim transactions and proven experience in delivering accurate and precise results
- Ability to work effectively cross-functionally
- Verifiable GED or High School Diploma is required
- Bachelor's Degree is strong preferred
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/