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CVS Health SIU Analyst in Hartford, Connecticut

Job Description

Under the direction of the Case Triage Supervisor, effectively initiates the triage of incoming healthcare fraud, waste, and abuse referrals/leads received in the Special Investigations Unit (SIU) from various internal and external sources• Effectively and timely handles the triage of healthcare fraud, waste, and abuse referrals received by the SIU from various internal and external sources • Runs initial Case Set Up reports and gathers additional information relevant to the case • Documents the receipt of new incoming referrals/leads for tracking purposes and prepares certain referrals for transfer to either Level 2 Triage or to Investigative Teams for investigation • Maintains clear, concise, accurate, and complete documentation in the case tracking application • Effectively utilizes available resources and technology while performing the referral triage function

Required Qualifications

• 1 year claim processing and/or customer service experience, or prior Medical Claim Analyst experience

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

• 3+ years claim processing and/or customer service experience, or prior Medical Claim Analyst experience• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently; or 3+ years of SIU Analyst experience. • Self-managed decision-maker, and looks beyond the immediate problem for root cause.

Education

High School diploma, G.E.D. or equivalent experience

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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