Experienced Claims Analyst – Waste & Abuse Ideator at careerzynith

Are you a detail-oriented and analytical individual with a passion for healthcare? Do you want to join a dynamic team that is dedicated to improving the lives of millions of people? Look no further than careerzynith, a leading healthcare company that is committed to delivering innovative solutions to the healthcare industry. As an Experienced Claims Analyst – Waste & Abuse Ideator at careerzynith, you will play a critical role in supporting the Waste and Misuse program within Investigation and Conduct Change. This is an exciting opportunity to join a team of professionals who are passionate about making a difference in the healthcare industry.

About careerzynith

careerzynith is a leading healthcare company that is dedicated to delivering innovative solutions to the healthcare industry. Our mission is to improve the lives of millions of people by providing high-quality, affordable healthcare services. We are committed to creating a culture of excellence, diversity, and inclusion, and we are proud to be a leader in the healthcare industry.

About the Role

As an Experienced Claims Analyst – Waste & Abuse Ideator at careerzynith, you will be responsible for managing an assortment of regulatory and project management tasks within the Waste and Misuse program. This will include daily oversight and management of clinical records stock, ongoing monitoring and answering system post box sections, and updating project documentation as needed. You will also identify and explore program-specific issues, recognize solutions, and lead the resolution of issues working with internal colleagues, external vendors, and suppliers.

Key Responsibilities

* Manage key business drivers for own area of responsibility

• Ability to communicate effectively with internal and external partners
• Ability to explain item vision and methodology for partners within A&BC, sees completely how the item aligns with CVSH
• Identify suitable data hotspots for examination solutions
• Direct daily monitoring of clinical record stock to choice result
• Work directly with key junior partners
• Ability to analyze an issue or complaint, plan solution, and specialty reaction
• Ability to work autonomously
• Assist with support of overall program documentation
• Drive commitment with colleagues
• Ability to seek a solution to issues by collaborating with others
• Will work with Program Supervisor to arrange and focus on
• Creates cycles of assessing prioritization of issues and goals
• Composes clear, succinct communication that precisely mirrors the information with direction

Required Capabilities

* 3-5 years of industry experience with healthcare claims, guarantee handling, and guarantee stages

• 3+ years in claims handling information and experience within ACAS, QNXT or HRP (HRP strongly preferred)
• Proficient in QuickBase
• Ability to work autonomously
• Strong logical and research skills
• Ability to explore data and identify data assets
• Conscientious
• Strong verbal and written communication skills

Preferred Capabilities

* Ability to interact with various groups at various levels

• Ability to use organization systems to obtain pertinent electronic documentation
• Knowledge of Aetna's strategies and techniques
• Demonstrated written and verbal communication skills with the ability to present data to different audiences
• Proficiency in Word, Excel, Data search tools, and the use of the Intranet/Web to explore data

Training

* Preferred Four-year degree or three years of equivalent experience in the healthcare industry

Pay Range

* The common compensation range for this job is:

• This pay range addresses the base hourly rate or base yearly full-time compensation for all situations in the job grade within which this position falls. The actual base compensation offer will depend on various factors including experience, education, geography, and other relevant elements. This position is eligible for a CVS Health reward, commission, or temporary motivator program in addition to the base compensation range listed above.

Benefits

* In addition to your pay, enjoy the benefits of an organization that puts its heart into truly caring for our partners and our communities. The organization offers a full range of clinical, dental, and vision benefits. Eligible employees may enroll in the organization's 401(k) retirement savings plan, and a Stock Purchase Plan is also available for eligible employees. The organization provides a fully paid term life insurance plan to qualified employees, and short-term and long-term disability benefits. CVS Health also offers various wellness programs, education assistance, free development courses, a CVS store discount program with participating partners. When it comes to downtime, organization 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 applicable state regulation and Company policies.

How to Apply

If you are a motivated individual ready to contribute to a thriving team, we encourage you to apply now! We are excited to review your application. Apply for this job