Northbrook, Illinois

Job Description
The Financial Analyst, Claims Adjustment role performs claims reprocessing to reflect the impact of benefit, eligibility, and other updates.

This reprocessing is a vital step in the Service Warranty process which begins with the identification of an issue and includes correcting the issue, reprocessing the claims to reflect the change, and finally administering the member communications and other activities that accompany these corrections.

This activity touches millions of claims a year and is used to address benefit coding errors, eligibility changes, program features, and client requests.


A successful candidate will manage multiple projects in a fast-paced, technically challenging, process-driven environment. They will possess excellent communication and time-management skills. They will enjoy working alongside a dozen other analysts as part of a high performing team, engaging across numerous functional
areas.


Tasks associated with this position include:


· Reprocess claims using Reverse & Resubmit tools that exist within RxClaim


· Extract claim and medical data from RxClaim


· Use CVS systems, Access, Excel and other tools to perform analyses and complete their tasks


· Summarize adjustment information into standard reports that reflect financial impact and
details


Analysts work closely with Sales, Account Management, IT, Medicare Part D Services, Client Audit, Benefits, and Implementation teams to manage and coordinate the work.
#analytictalent

Required Qualifications
2 or more years of analytical experience.

Preferred Qualifications
PBM Industry and plan design. RxClaim adjudication or benefits knowledge strongly preferred.
Medicare Part D - PBM or claim adjudication knowledge
Proficiency in IBM AS400
Understanding of SQL or other querying tools
Ability to program using Visual Basic for Applications
Understanding of data sets, tables/files, queries, joins, and other database concepts
Proficiency with Microsoft Excel, vlookup, if statements, and ability to quickly learn new functions.
Strong customer service focus that includes both internal and external customers.
Excellent verbal and written communication skills.
Aggressive pursuit of goals and completion of tasks when dependent on other parties

Education
High school diploma/GED required. Bachelor's degree preferred.

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Northbrook, Illinois

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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