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　　Position Summary National High Dollar Review Team is seeking to add a supporting project management position to the staff to better manage the high dollar claim review process. This position is very visible at a regional and national level. You will have an opportunity to work with Network Management Leadership as well as the National team. The candidate selected for this position will be a member of the National High Dollar Review unit. Sr Analyst will be responsible for administration of the high dollar claims review and approval process for multiple markets as assigned. Responsibilities include: 1. Act as point person for intake/output with multiple business partners including Medical Claims Management, Network and Approvers for Payment of the high dollar claims. 2. Keeps multiple High Dollar Review requests moving at the same time. 2. Complete Quick Base data entry for efficient management of high dollar claim inventory/review. 3. Review claims and complete the following: ∙ Check that member has been actively managed by Patient Management ∙ Verify that COB has been recently updated ∙ Verify Eligibility (including newborn eligibility) ∙ Determine if the claim is eligible for Subrogation ∙ Review # of days paid, compared to allowed amount ∙ Question high $$ drug/supply carve outs ∙ Obtain any additional information necessary for review 4. Attend workgroup calls, work nationally and regionally to improve process 5) Provider regular reporting to Market leadership. 6) Calculate savings associated with the project. 7) Navigates systems efficiently. Familiarity with provider contracting, claims management and patient management is preferred. Experience with Aetna systems (EPDB, ATV/MEDCOMPASS, ASD/GPS, HRP) is preferred. Required Qualifications Experience in claims management and with Aetna systems (EPDB, ATV/MEDCOMPASS, ASD/GPS) is preferred. 2-4 years’ experience in a Claims environment that includes ACAS and HRP and Traditional claim platforms. Preferred Qualifications Experience with provider contracting, provider relations, and project management support of projects that are multi-faceted and include cross functional collaboration between multiple departments Education

　　Bachelor's Degree

　　Pay Range

　　The typical pay range for this role is:

　　$43,700.00 - $102,000.00

　　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. 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 jobs.CVSHealth.com/benefits

　　CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

　　You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.