Oct 13, 2019
CVS Health Job Description The Senior Quality Assurance Analyst is responsible for providing analytical support for Medicaid and Exchange paid and rejected claims monitoring. For the senior level role, there is an emphasis put on complex claims adjudication such as clinical programs,transition fill, drug coverage, RxClaims benefits coding, and clients' benefit plan designs. The Quality Assurance Analyst position requires a strategic end-to-end view of claim adjudication, pinpointing compliance risks and managing resolution through completion. Additional responsibilities of the Senior Quality Assurance Analyst include: Analyzing moderate to complex claims to determine claims adjudication appropriateness aligned to state Medicaid requirements Resolving any claims discrepancies through working with various departments until resolved Reviewing, interpreting, analyzing and understanding state Medicaid guidance related to claim adjudication Mentoring and assisting consultants with daily claim review Required Qualifications 3+ years of quality or claims adjudication experience 1+ years of experience using the Microsoft Office Suites, especially Excel and Access 6+ months of experience with Medicaid or Medicaid regulatory guideline Preferred Qualifications Proven analytical skills and attention to detail Ability to effectively define issues, collect data, establish facts, and draw valid conclusions Knowledgeable of claim adjudication, benefit plan design, Medicaid and RxClaims adjudication Ability to interpret and integrate state Medicaid guidance into applicable processes Proficient in analyzing specific types of moderate to complex claim transactions and proven experience in delivering accurate and precise results Excellent verbal and written communication, demonstrated ability to document and present concepts in a clear, concise and logical manner Ability to meet deadlines with a variety of responsibilities Ability to creatively solve problems when dealing with a variety of variables in situations where standard resolutions do not exist Education Verifiable GED or High School Diploma is required Bachelor's Degree preferred Business Overview It's a new day in health care. Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all. We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability. CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT . We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team . Please note that we only accept applications for employment via this site. If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or email@example.com . For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.
Professional Diversity Network Scottsdale, AZ, USA Full-Time