Senior Analyst, Business Analytics

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

This position will primarily involve validation of supplier potential overpaid medical concepts on ACAS platform after the claim has been adjudicated using supplier referenced material and Aetna applications. Additional responsibilities will include tracking, monitoring and providing feedback on the supplier concept and their quality, providing root cause analysis, and acting as a liaison between suppliers, the validation team and network management to foster collaboration.



Required Qualifications

1+ years Claims processing system HRP
Ability to validate supplier overpayments as well as identify the root cause for the
overpayment.
Strong analytical and investigative skills
Excellent written communication and verbal skills to allow interaction with different audiences
Foster strong relationship between root cause, supplier validation and network team
Review of processes for areas of improvement and process optimization.
Partner and communicate with internal and external customers ensuring needs are met.
Provide Mentoring - may be a mentor to others.
Familiar with Microsoft Access and Excel.
Ability to research complex issues, pay attention to detail, and think outside the box.
Review of processes for areas of improvement and process optimization
Collaborating across areas to achieve results
Experience in a fast paced environment where quick adaptability was required
Must be flexible and able to adapt to changing priorities
Must be able to work independently and work collaboratively with others
Must be skilled in the use of PC/Mainframe based applications and have the ability to quickly learn new technology


Preferred Qualifications
Proficient with ACAS claim system to include but not limited to an understanding of claim adjudication, CPT, ICD9/ICD10, claim payment mechanisms, claim fee schedules and reimbursement mechanisms. Must be familiar with SCM and interpretation, ATV authorization review, and CCI member benefit review. Claim overpayment/medical cost savings knowledge.

Education
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Pay Range

The typical pay range for this role is:

$43,700.00 - $107,200.00

This 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 jobs.CVSHealth.com/benefits