Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary
Meritain Health is looking for someone who acts as an advocate for, and supports the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of work processes in claim processing and/or customer service that impact customer satisfaction, medical cost management, and operational efficiency. Consult and/or work cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers.
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Accountable for review and/or handling of quality audits. Uses analytical and statistical techniques and tools to evaluate and model business processes. Influences enhancements to business processes and system infrastructure to improve quality data. Utilizes quality assurance methodologies to review aspects of the organization. Performs audits including, but not limited to quality management and procedural documentation, in accordance with company policies. Conducts contractually required third party customer audits.
Obtains required data from the appropriate source (financial, systems, billing, etc.). Conducts audit and analysis; provides evaluation of findings. Develops and delivers recommendations or findings in a report format suitable to the audience.
Required Qualifications
- Must be flexible to work 8:00AM-5:00PM EDT or CDT.
- Collaborates effectively and professionally within internal and external partners.
- Able to concisely summarize large amounts of information, data and tailor the summary to the audience.
- 3-5 years prior claim audit experience
- Strong written and verbal communication skills
- Ability to multi-task and prioritize duties
- Attention to detailPreferred Qualifications
- Prior Risk Management experience
- Strong data analysis skills
- Knowledge of self-funded health plans and Third-Party Administrators.
Education
- Bachelor's Degree or equivalent experiencePay Range
The typical pay range for this role is:$46,988.00 - $102,000.00This 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.
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: 01/03/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.