Senior Claim Data Specialist

1 week ago

Melbourne, Victoria, Australia CVS Health Full time US$19 - US$32

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

  • Claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquires. In order to determine if there are any claim payment or denial issues that may affect Utilization Management, Enrollment, Claims, Configuration, Network, Contracting and/or Provider Data. 

  • If any issues are identified you will submit the necessary documents to specific areas to ensure all is updated and corrected. 

  • Submitting all projects and/or claims to be reprocessed in order to ensure provider contract is implemented effectively and avoid any further ongoing issues. 

  • Provider, internal and external education when required. 

  • Attending provider group meetings as well as individual meetings internally and/or externally.

  • Submitting projects within Excel.

Required Qualifications:

  • Must reside in Florida.

  • 2-3 years of provider claims experience.

  • 2-3 years of intermediate Excel experience with proficiency in formulas.

Preferred Qualifications:

  • Certified Professional Coder (CPC).

  • Provider Billing Knowledge with Professional and Hospital claims.

  • Bilingual in Spanish.

Education:

  • High School Diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$ $31.72

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. 
 

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit 

We anticipate the application window for this opening will close on: 09/02/2025

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

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