Follows established procedures to execute routine business support tasks for the Adjudication OCR function under general supervision.
Contacts Care Coordinators and Pharmacy staff regarding action items that need approval to proactively address and resolve requests and issues.
Performs review and research of rejected claims to take necessary action for resolution.
Handles work backlog of denied claims for timely resubmission and to ensure a high level of customer satisfaction and loyalty.
Maintains compliance with all government and regulatory requirements as well as compliance with the company's regulatory, safety, quality, and confidentiality protocols and standards.
Prepares feedback on adjudication operations and technology for internal teams and external stakeholders.
Develops effective relationships with all team members to ensure daily communication to resolve issues and prevent delays in service.
Communicates cross-functionally to implement new business and account activity and ensure alignment and adherence with company goals and objectives.
Ensures a high level of customer service, responding promptly, and following established adjudication protocols and guidelines when interacting with our internal business partners.Education
High school diploma or equivalent required.

Prior Relevant Work Experience
0-1 yearEssential Qualifications
Working knowledge of problem solving and decision making skills
Industrial Security Professional (ISP) preferred.Pay Range

The typical pay range for this role is:$17.00 - $31.30This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.