Supervisor Claim Operations at CVS Health

Hartford, Connecticut, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

2+ years prior work experience in a claim processing role
Success in claim processing/service, leadership, oral and written communication skills, keeping commitments and meeting deadlines, and strong business knowledge (2+ years preferred)
Proven track record of successfully dealing with multiple priorities, tasks, and fluctuating deadlines
Understands projecting work volumes and workload management (preferred)
Prior experience working in a quality assurance and production capacity (preferred)
Associate's degree (preferred)
High School Diploma and equivalent work experience
Ability to work collaboratively, communicate effectively with candor, identify risks early, strong organizational skills, and strong leadership skills including staff development
Ability to be flexible and creative in a fast-paced, constantly changing environment
Ability to effectively apply and enforce Aetna/CVS HR policies and practices

Responsibilities

Responsible for the overall supervision of Claim Processing employees
Achieve superior service performance through an integrated process of operational, quality, medical cost and resource management tools and applications; meeting and/or exceeding department and company goals
Develop, train, evaluate and coach staff to provide cost effective claim review/processing and claim service while ensuring compliance and quality standards are met
Manage and monitor daily inventory to ensure production standards are met and/or exceeded
Allocate resources to meet volume and performance standards including Key Performance Metrics (KPMs) and Performance Guarantees
Identify and execute team process improvement
Assess individual and team performance using all available tools/applications and provide timely results and candid feedback regularly and by using mid-year and annual scorecards
Act as a liaison between staff and other areas, including management, plan sponsors, provider teams, communicating workflows, results, ideas, and solutions
Utilize available incentive programs to reward, recognize, and celebrate team and individual successes
Present a positive, professional image of the company at all times

Skills

Claim Processing

Staff Supervision

Performance Management

Resource Allocation

Process Improvement

Team Leadership

Quality Standards

Risk Identification

Organizational Skills

Communication

Inventory Management

KPMs

Scorecards

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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