Claims investigator Jobs in High Point, NC

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Requirement On site in High Point, NC - Hybrid Model

Position Summary

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.

Fundamental Components :

• 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.
• Must have the ability to work collaboratively, ability to communicate effectively with candor, ability to identify risks early, strong organizational skills, and strong leadership skills including staff development.
• 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.
• Acts 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.
• Demonstrates the ability to be flexible and creative in a fast paced, constantly changing environment.
• Candidate will be expected to effectively apply and enforce Aetna / CVS HR policies and practices.
• The candidate for this position will need to present a positive, professional image of the company at all times.

Required Qualifications :

Preferred Qualifications :

Education :

High School Diploma or equivalent GED

Pay Range

The typical pay range for this role is :

40,600.00 - $76,500.00

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.