The position is primarily Monday through Friday, and the candidate can work the hours of their time zone but must have flexibility for meetings which will occur during 8am-5pm EST.

The Senior Analytic Consultant is responsible for the analyzing issues related to appeals and related areas. One should be proficient in performing root cause analysis and identifying potential corrective actions.

Fundamental Components:

• • Utilize analytical reports involving claims and appeals data to identify issues.
  • Coordinate with cross functional team to explain identified issues and participate in solution discussion.
  • Facilitate solution identification and implementation of root cause correction actions.
  • Able to clearly identify whether the issues are resulting from clinical or administrative process related to appeals.
  • Perform ad hoc analysis of small set of issues and ability to extrapolate it to large data set to make meaningful conclusions.
  • Prepare presentation materials to explain issues in easy-to-understand format.
  • Prepare recommendations based on analysis performed.
  • Develops project plans and timelines; responsible for project commitments to quality and on-time deliverables.
  • Presents analysis and reports to internal customers and stakeholders.
  • Acts as a mentor to other analysts.

Required Qualifications

- Advanced knowledge of Medicare appeals process and the associated processing system

- 7 or more years' experience with a combination of one or more of the following skillsets: data analysis, Medicare compliance, Aetna clinical policy

- AND ability to analyze data from dashboard
- Experience translating business requirements into technical requirements for building automation capabilities. CPT codes, medical policy, claims processing knowledge and other supporting areas involved in appeals processing.
- Experience with STAR metric impact related to appeals processing .
- Must be comfortable with using online, independent learning to learn/research new skills/systems.
- Ability to communicate technical ideas and results to non-technical clients in written and verbal form.
- Ability to compose training documents and lead training sessions on new tools.
- Experience leading project teams; strong collaboration skills with the ability to work effectively with all levels of management and staff.
- Strong collaboration and communication skills within and across teams.
- Strong problem-solving, analytical, critical thinking and project management skills.
- Ability to manage conflicting priorities and multiple projects concurrently.Pay Range

The typical pay range for this role is:$46,988.00 - $112,200.00This 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: 01/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.