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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.

Position Summary

Manages day-to-day of team by providing strategic leadership and overseeing the operations of the claims processing team(s). Directs work flow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics, managing and developing a team of claims support individuals, implementing process improvement initiatives, and fostering collaboration with internal and external stakeholders to optimize claim processing, minimize errors, and enhance overall operational effectiveness and customer satisfaction. What you will do Ensures the efficient and timely processing of claims by effectively managing the workflow processing and completion within the department.

• Implements and maintains quality control processes to ensure accuracy and consistency in claim processing. Advises team members in resolving complex or escalated claims issues by providing guidance on claim handling procedures, policy interpretation, and compliance with industry regulations.

• Analyzes key performance indicators (KPIs) to assess the productivity and quality of the claims department and prepares regular performance reports for management.

• Streamlines and improves claim processing procedures by collaborating with cross-functional teams to implement process enhancements, automation, and system upgrades to increase efficiency and accuracy.

• Ensures consistent compliance with applicable laws, regulations, and industry standards related to claims processing. Assists management in the development of the department's budget by monitoring expenses, analyzing budget variances, and recommending cost-saving measures while ensuring operational effectiveness and maintaining service quality.

• Establishes a positive work environment, encouraging professional development, and addressing any performance issues.

• Directs tasks and responsibilities to team members, ensuring the claim workload distribution is equitable and efficient.

Required Qualifications

•Must report into Franklin, TN Tuesday- Thursday

3-5 years work experience

• Working knowledge of collaboration and teamwork

• Working knowledge of execution and delivery (planning, delivering, and supporting) skills

• Working knowledge of business intelligence

• Working knowledge of problem solving and decision making skills

• Adept at growth mindset (agility and developing yourself and others) skills

Preferred Qualifications

Healthcare claims experience

2 years lead experience

Education Post secondary /high school education or specialized training, i.e., technical/vocational programs or work equivalent.

Pay Range

The typical pay range for this role is:

$43,888.00 - $85,068.00

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/18/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.