We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
This position is a key member of the Claim Optimization Technical Team and plays a critical role in supporting the Commercial Claim Rework Reporting program, as well as other reporting needs across the Claim Center of Excellence. The role is responsible for preparing and delivering production and ad hoc reporting as well as other data needs to support claim operations for all lines of business.
Key responsibilities include developing new reports as needed, performing data analysis using multiple system data sources, and transforming complex data into clear, actionable insights that support organizational initiatives. Success in this role requires the ability to effectively manage multiple priorities while maintaining a high level of accuracy and timeliness.
Strong communication and collaboration skills are essential, as this individual will partner closely with the Claims organization and supporting teams to identify key data elements, define reporting criteria, and deliver effective, data driven solutions.
Required Qualifications
5+ years of directly related experience
3+ years of healthcare experience
Knowledge of Aetna claim processing platform(s) (ACAS/HRP/QNXT)
Experience with ETL tools such as Alteryx and/or Dataiku
Strong Microsoft Excel skills, including VBA
Data analytics experience with the ability to analyze, transform, and present data into meaningful insights
5-7 years of Service Operations experience
Strong communication skills
Proven track record in meeting milestones
Flexible and adaptable; able to work in ambiguous situations
Ability to communicate effectively with all levels of management
Demonstrates excellent active listening, written and verbal communication skills
Able to work effectively with all levels in the organization
Work style that is collaborative, open-door, thoughtful, accessible and people oriented
Possesses strong engagement and organizational skills; can quickly and effectively translate high-level strategic direction and drive both progress and resolution, absorb feedback and quickly incorporate it into work product and seek collaborative problem-solving resolutions across the governance structure
Preferred Qualifications
Experience with Microsoft Access
Experience with SQL coding and query development
Intermediate to advanced skills in Power BI for data visualization and reporting
Understanding of claims data and claims processing workflows
5-7 years of experience related to standards, measurements, technology, systems and processes, including project consultation
*We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
Aetna Service Operations office/hub locations will be discussed with the selected candidate.
Education
Bachelor Degree or equivalent experience
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,300.00 - $145,860.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.