Phoenix, Arizona

Job Description
-Research incoming electronic appeal requests to identify if appropriate for unit based on published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet appeals criteria.
-Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process.
-Identify and research all components within provider/practitioner appeals for all products and services.
-Ability to meet demands of a high paced environment with tight turnaround times.
-Ability to make appropriate decisions based upon Aetna's current policies and guidelines.
-Collaborative working relationships.
-Thorough knowledge of provider appeals policies
-Strong analytical skills focusing on accuracy and attention to detail.
-Excellent verbal and written communications skills.
-Computer literacy in order to navigate through internal/external computer systems , including Excel and Microsoft Word.

Required Qualifications
-Experience in reading or researching benefit language.
-1-2 years’ experience that includes but is not limited to claim platforms, products, and benefits; patient management; compliance and regulatory analysis; customer service or audit experience.
Preferred Qualifications :
-Experience in research and analysis of claim processing a plus
Education :
High School diploma or GED.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.


Preferred Qualifications
Experience in research and analysis of claim processing a plus

Education
Some college preferred.
High School or GED equivalent.

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

Phoenix, Arizona

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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