Hartford, Connecticut

Job Description
- This position is for a Product Consultant working on the NextGen/Health Rules Payor application.

- Successful candidates will have a mix of product and benefits knowledge and their use in claims adjudication processing.

-If your goal is to combine your strong healthcare product/benefit knowledge, with a bent for analytic and technical implementation, then this is the ideal job for you.

- Experience with coding standards, ICD 10, CPT and HCPC codes would be beneficial. You will also need to evaluate the impact of CMS and state legislation on benefit plans.

- This is a unique opportunity to be on a dynamic Team that is shaping the new delivery of healthcare.

Required Qualifications
- One to three years prior experience using the Health Rules Payor application, specifically configuration of benefit plan components, value lists and service categories

- Prior experience developing and implementing benefit plans for Medicare Group and Individual segments inclusive of DSNP, VBID and Advantage plans

- Two to four years claims payment experience ~ ideally on Health Rules Payor

- Demonstrated strong analytic skills in defining requirements, testing and implementing product and plans

- Understanding of provider networks and pricing in claims adjudication processing

- Ability to work on multiple tasks simultaneously and deliver assignments on time and with quality

Preferred Qualifications
- Advanced Excel skills

Education
- Associates or Bachelor's Degree

Business Overview
At Aetna, a CVS Health company, 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 are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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

Hartford, Connecticut

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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