Analyst - Behavioral Health Business Claim Analytics

CVS Health is the nation’s premier health innovation company, helping people on their path to better health. We have an exciting opportunity for a highly motivated candidate to join the rapidly growing Behavioral Health Payment Integrity and Customer Relations team that ensures behavioral health claims are paid correctly and focuses on reducing behavioral health member and provider abrasion. In the role of Analyst – Behavioral Health Business Claim Analytics, you will be responsible for supporting the team in these goals. You will work in a fast-paced environment with tight deadlines, requiring individual accountability and strong ownership skills.

Responsibilities:

• Work with members or providers to resolve escalated claim concerns via email or phone
• Identify improvement opportunities and provide input on potential solutions to support behavioral health claim payment more effectively
• Process/reprocess claims or submit rework projects as needed
• Effectively and accurately review behavioral health claims and provide insight into trends
• Monitor communications from members and providers regarding behavioral health claims and image these requests for timely processing
• Process behavioral health claims for escalated member/providers situations and known system gaps supported by claim processing in the department
• Ownership of ongoing monthly/quarterly proactive reviews based on business needs
• Ensure claim reviews are resolved accurately by the specified due date
• Maintain a specialized knowledge of behavioral health claim processing and policy impacts
• Support the team by providing input for the creation of insightful analytical-based presentations
• Advocate for members by improving timeliness and accuracy of behavioral health claim payments

Pay Range
The typical pay range for this role is:
Minimum: 40,600
Maximum: 83,400

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

Required Qualifications

• Excellent critical thinking, conflict management, and prioritization skills
• Strong organization and time management skills – ability to balance a high-volume workload against rapidly changing priorities
• Excellent communication skills, written and verbal
• Self-motivated, with a strong attention to detail and the ability to work independently with little supervision
• Ability to learn new software
• Extensive experience with Microsoft products: Outlook, Excel (with large data sets), Word, efficiency and flexibility to meet critical turnaround objectives
• Strong collaborative skills

Preferred Qualifications

• Healthcare sector experience preferred
• Anticipates and prevents problems and roadblocks before they occur
• Customer service experience
• Knowledge of Aetna’s commercial products/benefits, policies, and systems
• Experience with ACAS claim system, ATV, MedCompass, CCI, ECHS/E2I, EPDB

Education
High School and/or College Degree

Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected 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.