Senior Claim Data Specialist
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 SummaryThe Senior Claim Data Specialist acts as a source of information for Oral Surgery processors and customer service representatives. Responsibilities include assisting CSRs with complex calls, handling escalations, coaching, and collaborating across multiple departments. Critical thinking and strong problem-solving skills are required.
Subject matter expert for workflows, policies, components of systems and daily operations and programs
Use analytical and statistical techniques and tools to plan and perform research and analysis of processes.
Report results and make recommendations (e.g., training needs, quality controls and procedures).
In partnership with business owners, support the design and development of new processes.
May provide guidance or expertise to staff.
Facilitate team sessions to develop processes and/or resolve issues.
Support the creation of communication strategies and presentation for both internal and external customers to educate and address continuous quality improvement initiatives.
Analyze and resolve complex claim scenarios within established time frames.
Analyze customer feedback and other measures.
Required Qualifications
1-2 Years Oral Surgery knowledge
2+ Years Experience in Oral Surgery Claims and Customer Service
Outstanding claim processing, customer service skills and dedication to providing exceptional customer care
Strong communication skills, both written and verbal
Ability to multitask and operate in fast paced, team environment
Excellent organizational ability
Preferred Qualifications
Critical thinking
Proficient in utilizing resources to resolve complex issues
Detail oriented
Conflict resolution skills
Education
High School Diploma required
Pay RangeThe typical pay range for this role is:$18.50 - $42.35This 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.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: 01/10/2025Qualified 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.