Sandy, Utah

Job Description
Eligible to Apply Anywhere Within US

• Develops, trains, evaluates and coaches staff (10-15 Claims Reps) to provide cost effective claim review/processing while ensuring quality standards are met. Is visible and available to staff to answer questions, monitor production and quality, providing ongoing feedback
• Utilizes available incentive programs to reward, recognize and celebrate team and individual successes.
• Assesses individual and team performance on a regular basis and provide candid and timely feedback regarding developmental and training needs; includes completion of monthly and annual scorecards.
• Establishes clear vision aligned with company values; motivates others to balance customer needs and business success.
• Manages and monitors daily workflow and reporting to ensure business objectives are maintained and accurately reported; ensures resources are aligned appropriately across function and/or service center.
• Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.
• Leverages the unit’s resources to resolve claim inquiries or problems by identifying the issue, obtaining applicable information, perform root cause analysis and generate and act upon the solutions.
• Remove barriers to job performance and ensure regulatory compliance.
• Attracts, selects and retains high caliber, diverse talent able to successfully achieve or exceed business goals. Build a cohesive team that works well together.
• Acts as liaison between staff and other areas, including management, all segments, provider teams etc., communicating workflow results, ideas and solutions.
• Proactively analyzes claim/constituent data, identifies trends and issues. Recognizes and acts on the needs to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.
• Effectively applies and enforces Aetna/CVS policies and practices ie; FML/EML, attendance, Code of Conduct, Disciplinary Guidelines
• May audit and adjudicate high dollar claims that exceed processor draft authority limits.
• Initiate and maintain partnerships with others throughout Aetna/CVS organization and various vendors.

Required Qualifications
Required Skills
Leadership, collaborating for results, leadership-Engaging and Developing people, Service-providing solutions to Constituent Needs

Preferred Qualifications
Background Experience
• 3-5+ years’ experience in managing or participating in high volume transaction processing
• Proven strong leadership skills as a performer/leader on large teams
• 1-3 years prior leadership/team lead experience highly desired
• Healthcare experience preferred.

Desired Skills
General business – Communicating for Impact Leadership-Driving change, Service-Improving constituent-Focused Processes
Minimal Functional Experience
Claim-Claim processing Medical-Medicare, Claim-Policies & Procedures

Medical and/or dental claim experience preferred
Must be very focused, detail oriented and quality driven. Minimum production and quality standards are expected by your team and performance managed. Coaching and development is a primary responsibility.

Education
- Education and Certification Requirements.
- Associate’s degree or equivalent work experience.

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

Sandy, Utah

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