At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
This position is directly responsible for the supervision of our workers' compensation claims program with financial exposure for CVS. This involves the oversight of all workers' compensation claims in an assigned territory that are handled by insurance carriers and Third Party Administrators (TPA). This position is directly responsible for ensuring adherence to claim handling guidelines, analyzing TPA performance and directing claims handling. In addition, this position requires the ability to field and provide solutions on a high volume of inquiries from the CVS business units and departments.
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- Directly responsible for the oversight of incurred dollars in workers' compensation losses and holding the TPA accountable to reserving philosophies which directly impact the financial strength of CVS.
- Oversight for the daily work product of multiple lost time and medical only workers' compensation adjusters in your assigned territory located at the workers' compensation TPA offices nationwide.
- Review all settlement authorization requests and promptly grant settlement authority or if above your authority, provide written recommendation to the Sr. Manager, Workers' Compensation. Present catastrophic losses and/or complex claims to CVS Senior Leadership.
- Interact with TPA's, managed care vendors, defense counsel and various vendors on a daily basis. Act as the liaison on various requests for information needed to adjudicate claims.
- Lead large reserve increase roundtable discussions as well as claim strategy roundtables with TPA Personnel/Defense Counsel/Medical Management on high exposure/complex cases.
- Interact with CVS personnel on a daily basis including but not limited to: Injured colleagues and their Managers, Human Resource Business Partners, Leave of Absence Managers, Safety, Loss Prevention, Retail Pharmacy Store Management & District Management, Distribution Center Management, Minute Clinic and Pharmacy Benefit Manager personnel.
- Conduct claim reviews and/or attend closing project meetings TPA/insurance carriers to insure compliance with service instructions and adherence to CVS's claim reserving philosophy.
- This position to include frequent claim file reviews and follow-up to ensure compliance with service instructions and adherence to CVS's claim reserving philosophy.
- Work in conjunction with the Sr. Manager of Workers' Compensation on special projects and/or audits for the Risk Management Department as needed.
- 1+ year of experience handling Lost Time workers' compensation claims and/or equivalent experience with TPA oversight. Insurance designations a plus.
- Excellent analytical, organizational, written and communication skills.
High School Diploma or Equivalent Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$43,888.00 - $93,574.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.