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Senior Claim Data Specialist (Must reside in Oklahoma) at CVS Health
Oklahoma City, OK 73102, USA - Full Time
Skills Needed
High Stress Environment, Ged, Medical Coding, Communication Skills, Sql, Qnxt, Outlook, Strategic Thinking, Excel, Teams, Technical Writing
Qualification
Diploma
Experience Required
Minimum 1 year(s)
Pharmacy Technician at CVS Health
Saint Petersburg, Saint Petersburg, Russia - Full Time
Skills Needed
Customer Service, Communication Skills, Mathematical Reasoning, Problem Resolution, Attention To Detail, Team Orientation, Flexibility, Empathy, Inventory Management, Prescription Fulfillment, Patient Care, Regulatory Compliance, Training, Technical Knowledge, Safety Procedures
Specialization
Candidates must comply with state board of pharmacy requirements, including age and education. A high school diploma or equivalent is required, and state-level licensure and national certification may vary.
HIMS Quality Assurance Analyst at ECU Health
Greenville, NC 27835, USA - Full Time
Skills Needed
Health Information Management, Eligibility, Registered Health Information Administrator, Information Technology, Rhia
Specialization
Health information management and 2 or more relevant years of experience is required
Qualification
Graduate
RN New Graduate Nurse - Emergency Department at UNC Health
Raleigh, NC 27607, USA - Full Time
Skills Needed
Clinical Care, Life Support
Specialization
Seven years of employment date
Qualification
Graduate
Experience Required
Minimum 7 year(s)
Manager - Scrum Master at CVS Health
Juneau, AK 99801, USA - Full Time
Skills Needed
Sharepoint, Microsoft Teams, Collaboration Tools, Agility, Forecasting, Confluence, Healthcare Industry, Budgeting, Collaboration, Teams, Software Development, Teamwork
Qualification
Graduate
Experience Required
Minimum 10 year(s)
Epic Health Information Exchange Analyst at VHC Health
Alexandria, VA 22304, USA - Full Time
Skills Needed
Good Communication Skills
Specialization
A health science or business field or an equivalent level of professional experience desired
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Registered Midwife Level 1 - Womens, Youth and Childrens at ACT Health
Canberra, Australian Capital Territory, Australia - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Principal Engineer - AI/Agentics at CVS Health
Woonsocket, RI 02895, USA - Full Time
Skills Needed
Multi Agent Systems, Collaborative Environment, Scratch, Security, Computer Science, Reinforcement Learning, Cross Functional Alignment, Leadership, Rabbitmq, Apache Kafka, Agent Development, Infrastructure, Neo4j, Mitigation Strategies, A2a
Specialization
Computer science engineering or related field
Qualification
Graduate
Medical Laboratory Technician, Non-Certified - Evenings at SSM Health
Madison, Wisconsin, United States - Full Time
Skills Needed
Laboratory Tests, Specimen Handling, Test Result Confirmation, Quality Control, Instrument Calibration, Hazardous Material Storage, Continuing Education, Proficiency Testing, Microscopic Tests, Bacteriologic Tests, Chemical Tests, Data Entry, Oral Communication, Vision, Hearing
Specialization
An Associate’s degree in Chemical or Biological Science is required, with no prior experience necessary. Physical requirements include frequent lifting and use of vision and hearing.
Clinical Support Tech I - Childrens Developmental and Behavioral Chapel HIl at UNC Health
Chapel Hill, NC 27514, USA - Full Time
Skills Needed
Health, Computer Skills
Qualification
Diploma
Child and Family Licensed Mental Health Therapist (ages 5+) | (Remote) at aptihealth
New York, New York, USA - Full Time
Skills Needed
Children
Qualification
Graduate
Experience Required
Minimum 3 year(s)
*RN-Emergency Department Regional Float Pool* at SSM Health
Des Peres, Missouri, United States - Full Time
Skills Needed
Direct Nursing Care, Complex Assessments, Triage, Patient Flow, Health Education, Leadership, Evidence Based Practice, Emergency Nursing, Communication, Patient Safety, Cultural Sensitivity, Health Promotion, Clinical Needs, Assessment Data Analysis, Individualized Care, Safe Practice Environment
Specialization
Candidates must be graduates of an accredited nursing school with at least one year of registered nurse experience. Required certifications include BLS, RN license, and additional advanced life support certifications.
Experience Required
Minimum 2 year(s)
Manager Clinical Education at CHI Health
Papillion, NE 68046, USA - Full Time
Skills Needed
Nursing Education, Training, Research, Collaboration, Clinical Education, Life Support, Organizational Initiatives, Service Levels, Partnerships, Oversight, Leadership, Overtime
Specialization
Nursing
Qualification
Graduate
Staff Software Development Engineer at CVS Health
Woonsocket, RI 02895, USA - Full Time
Skills Needed
Jenkins, Security Audits, Kanban, Integration Testing, Distributed Teams, Data Structures, Spring Boot, Milestones, Microservices, Unit Testing, Azure, Algorithms, Java, Github, Scaled Agile Framework, Development Projects, Apache Kafka, Programming Languages, Ownership
Qualification
Diploma
Experience Required
Minimum 3 year(s)
CNA - Inpatient Services - Nights at SSM Health
Monroe, Wisconsin, United States - Full Time
Skills Needed
Patient Care, Vital Signs Monitoring, Documentation, Communication, Personal Hygiene Assistance, Patient Education, Clerical Duties, Equipment Operation, Basic Life Support, Nursing Activities, Team Collaboration, Patient Discharge, Data Entry, Specimen Collection, Ostomy Care, Catheter Care
Specialization
Wisconsin State-issued CNA Certification is required. No prior experience is necessary for this position.
Physiotherapist at WPC Health
Surrey, BC, Canada - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Store Associate at CVS Health
Greenville, South Carolina, United States - Full Time
Skills Needed
Customer Service, Cashier Duties, Inventory Management, Teamwork, Compassion, Problem Solving, Communication, Retail Operations, Sales Support, Pharmacy Assistance, Service Advocacy, Greeting Customers, Visual Acuity, Lifting, Restocking, Attention To Detail
Specialization
Candidates must be at least 16 years old and able to lift up to 35 lbs. A high school diploma is preferred but not required, and previous retail or customer service experience is advantageous.
Client Relations Manager at PDI Health
Harrisburg, PA 17025, USA - Full Time
Skills Needed
Time Management, Crm, Communication Skills, Databases, Emotional Intelligence, Customer Service Skills
Qualification
Graduate
Pharmacy Intern at CVS Health
New York, New York, United States - Full Time
Skills Needed
Patient Safety, Pharmacy Professional Practice, Regulatory Requirements, Quality Assurance, Customer Service, Inventory Management, Workflow Management, Communication Skills, Presentation Skills, Empathy, Collaboration, Team Culture, Microsoft Office Suite, Immunization Eligibility
Specialization
Candidates must be accepted into or actively enrolled in an ACPE accredited college or school of pharmacy. Strong communication skills and the ability to complete required training and obtain licensure are essential.
Shift Supervisor Trainee at CVS Health
Austin, Texas, United States - Full Time
Skills Needed
Management, Customer Service, Communication, Analytical Skills, Deductive Reasoning, Computer Skills
Specialization
Candidates should possess deductive reasoning ability, analytical skills, and advanced communication skills. A high school diploma is preferred but not required, and experience in retail is advantageous.
Senior Claim Data Specialist (Must reside in Oklahoma) at CVS Health
Oklahoma City, OK 73102, USA -
Full Time

Start Date

Immediate

Expiry Date

19 Nov, 25

Salary

31.72

Posted On

19 Aug, 25

Experience

1 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

High Stress Environment, Ged, Medical Coding, Communication Skills, Sql, Qnxt, Outlook, Strategic Thinking, Excel, Teams, Technical Writing

Industry

Insurance

Description

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

The Senior Claim Data Specialist handles end-to-end processes associated with claim data management. This person identifies and addresses issues impacting auto-adjudication levels, claim accuracy, and alignment with internal and external (regulatory) policy.

REQUIRED QUALIFICATIONS:

  • 2+ years of experience with medical claims and/or claims processing.
  • At least 1 year of experience with medical coding.
  • Expert knowledge in Microsoft Suite applications (Teams, Outlook, Word, Excel, etc.).
  • Must reside in Oklahoma.

PREFERRED QUALIFICATIONS:

  • Previous experience with QNXT, Remedy, and/or SQL.
  • Knowledge of Oklahoma Medicaid Program.
  • Previous experience in technical writing.
  • Previous experience in creating workflows.
  • Previous experience in working remotely.
  • Demonstrated successful project completion, specifically within a team environment.
  • Demonstrated analytical and strategic thinking; ability to output analysis into easily digestible summaries.
  • Ability to prioritize tasks based on type and impact.
  • Ability to pivot quickly with competing priorities.
  • Demonstrated adaptability, with a keen ability to work in a matrixed and potentially high-stress environment.
  • Cross-departmental communication skills.
  • Demonstrated professionalism, in both verbal and written communications.
  • Strong knowledge of benefit plans.
  • Ability to work collaboratively.
  • Ability to spot trends quickly and accurately.
  • Ability to take initiative as needed.
  • Demonstrated problem-solving skills.
  • Previous experience with creating and analyzing reports.

EDUCATION

  • High school diploma or GED.

How To Apply:

Incase you would like to apply to this job directly from the source, please click here

Responsibilities
  • Handle phone and written inquiries from internal teams regarding claims adjudication outcomes, systems benefit configuration issues, appeals, and operations workflows.
  • Ensure all compliance requirements are satisfied and that all payments are made against company practices and procedures.
  • Identify, report, and prevent possible claim overpayments, underpayments, and any other irregularities.
  • Perform claims re-work calculations.
  • Review and submit requests for auto-adjudication.
  • Review and resolve pended claims with provider and/or billing data mismatches.
  • Occasionally make outbound calls, in collaboration with Provider Services, to offer provider education.
  • Perform review of submitted claims and configuration projects and results.
  • Report financial impact of completed tasks.
  • Look at trends in data and perform subsequent analysis.
  • Make recommendations as needed and address risks based on research and analysis.
  • Perform other duties as assigned.
Senior Claim Data Specialist (Must reside in Oklahoma) at CVS Health
Oklahoma City, OK 73102, USA - Full Time
Skills Needed
High Stress Environment, Ged, Medical Coding, Communication Skills, Sql, Qnxt, Outlook, Strategic Thinking, Excel, Teams, Technical Writing
Qualification
Diploma
Experience Required
Minimum 1 year(s)
Pharmacy Technician at CVS Health
Saint Petersburg, Saint Petersburg, Russia - Full Time
Skills Needed
Customer Service, Communication Skills, Mathematical Reasoning, Problem Resolution, Attention To Detail, Team Orientation, Flexibility, Empathy, Inventory Management, Prescription Fulfillment, Patient Care, Regulatory Compliance, Training, Technical Knowledge, Safety Procedures
Specialization
Candidates must comply with state board of pharmacy requirements, including age and education. A high school diploma or equivalent is required, and state-level licensure and national certification may vary.
HIMS Quality Assurance Analyst at ECU Health
Greenville, NC 27835, USA - Full Time
Skills Needed
Health Information Management, Eligibility, Registered Health Information Administrator, Information Technology, Rhia
Specialization
Health information management and 2 or more relevant years of experience is required
Qualification
Graduate
RN New Graduate Nurse - Emergency Department at UNC Health
Raleigh, NC 27607, USA - Full Time
Skills Needed
Clinical Care, Life Support
Specialization
Seven years of employment date
Qualification
Graduate
Experience Required
Minimum 7 year(s)
Manager - Scrum Master at CVS Health
Juneau, AK 99801, USA - Full Time
Skills Needed
Sharepoint, Microsoft Teams, Collaboration Tools, Agility, Forecasting, Confluence, Healthcare Industry, Budgeting, Collaboration, Teams, Software Development, Teamwork
Qualification
Graduate
Experience Required
Minimum 10 year(s)
Epic Health Information Exchange Analyst at VHC Health
Alexandria, VA 22304, USA - Full Time
Skills Needed
Good Communication Skills
Specialization
A health science or business field or an equivalent level of professional experience desired
Qualification
Graduate
Experience Required
Minimum 1 year(s)
Registered Midwife Level 1 - Womens, Youth and Childrens at ACT Health
Canberra, Australian Capital Territory, Australia - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Principal Engineer - AI/Agentics at CVS Health
Woonsocket, RI 02895, USA - Full Time
Skills Needed
Multi Agent Systems, Collaborative Environment, Scratch, Security, Computer Science, Reinforcement Learning, Cross Functional Alignment, Leadership, Rabbitmq, Apache Kafka, Agent Development, Infrastructure, Neo4j, Mitigation Strategies, A2a
Specialization
Computer science engineering or related field
Qualification
Graduate
Medical Laboratory Technician, Non-Certified - Evenings at SSM Health
Madison, Wisconsin, United States - Full Time
Skills Needed
Laboratory Tests, Specimen Handling, Test Result Confirmation, Quality Control, Instrument Calibration, Hazardous Material Storage, Continuing Education, Proficiency Testing, Microscopic Tests, Bacteriologic Tests, Chemical Tests, Data Entry, Oral Communication, Vision, Hearing
Specialization
An Associate’s degree in Chemical or Biological Science is required, with no prior experience necessary. Physical requirements include frequent lifting and use of vision and hearing.
Clinical Support Tech I - Childrens Developmental and Behavioral Chapel HIl at UNC Health
Chapel Hill, NC 27514, USA - Full Time
Skills Needed
Health, Computer Skills
Qualification
Diploma
Child and Family Licensed Mental Health Therapist (ages 5+) | (Remote) at aptihealth
New York, New York, USA - Full Time
Skills Needed
Children
Qualification
Graduate
Experience Required
Minimum 3 year(s)
*RN-Emergency Department Regional Float Pool* at SSM Health
Des Peres, Missouri, United States - Full Time
Skills Needed
Direct Nursing Care, Complex Assessments, Triage, Patient Flow, Health Education, Leadership, Evidence Based Practice, Emergency Nursing, Communication, Patient Safety, Cultural Sensitivity, Health Promotion, Clinical Needs, Assessment Data Analysis, Individualized Care, Safe Practice Environment
Specialization
Candidates must be graduates of an accredited nursing school with at least one year of registered nurse experience. Required certifications include BLS, RN license, and additional advanced life support certifications.
Experience Required
Minimum 2 year(s)
Manager Clinical Education at CHI Health
Papillion, NE 68046, USA - Full Time
Skills Needed
Nursing Education, Training, Research, Collaboration, Clinical Education, Life Support, Organizational Initiatives, Service Levels, Partnerships, Oversight, Leadership, Overtime
Specialization
Nursing
Qualification
Graduate
Staff Software Development Engineer at CVS Health
Woonsocket, RI 02895, USA - Full Time
Skills Needed
Jenkins, Security Audits, Kanban, Integration Testing, Distributed Teams, Data Structures, Spring Boot, Milestones, Microservices, Unit Testing, Azure, Algorithms, Java, Github, Scaled Agile Framework, Development Projects, Apache Kafka, Programming Languages, Ownership
Qualification
Diploma
Experience Required
Minimum 3 year(s)
CNA - Inpatient Services - Nights at SSM Health
Monroe, Wisconsin, United States - Full Time
Skills Needed
Patient Care, Vital Signs Monitoring, Documentation, Communication, Personal Hygiene Assistance, Patient Education, Clerical Duties, Equipment Operation, Basic Life Support, Nursing Activities, Team Collaboration, Patient Discharge, Data Entry, Specimen Collection, Ostomy Care, Catheter Care
Specialization
Wisconsin State-issued CNA Certification is required. No prior experience is necessary for this position.
Physiotherapist at WPC Health
Surrey, BC, Canada - Full Time
Skills Needed
Good Communication Skills
Qualification
Graduate
Store Associate at CVS Health
Greenville, South Carolina, United States - Full Time
Skills Needed
Customer Service, Cashier Duties, Inventory Management, Teamwork, Compassion, Problem Solving, Communication, Retail Operations, Sales Support, Pharmacy Assistance, Service Advocacy, Greeting Customers, Visual Acuity, Lifting, Restocking, Attention To Detail
Specialization
Candidates must be at least 16 years old and able to lift up to 35 lbs. A high school diploma is preferred but not required, and previous retail or customer service experience is advantageous.
Client Relations Manager at PDI Health
Harrisburg, PA 17025, USA - Full Time
Skills Needed
Time Management, Crm, Communication Skills, Databases, Emotional Intelligence, Customer Service Skills
Qualification
Graduate
Pharmacy Intern at CVS Health
New York, New York, United States - Full Time
Skills Needed
Patient Safety, Pharmacy Professional Practice, Regulatory Requirements, Quality Assurance, Customer Service, Inventory Management, Workflow Management, Communication Skills, Presentation Skills, Empathy, Collaboration, Team Culture, Microsoft Office Suite, Immunization Eligibility
Specialization
Candidates must be accepted into or actively enrolled in an ACPE accredited college or school of pharmacy. Strong communication skills and the ability to complete required training and obtain licensure are essential.
Shift Supervisor Trainee at CVS Health
Austin, Texas, United States - Full Time
Skills Needed
Management, Customer Service, Communication, Analytical Skills, Deductive Reasoning, Computer Skills
Specialization
Candidates should possess deductive reasoning ability, analytical skills, and advanced communication skills. A high school diploma is preferred but not required, and experience in retail is advantageous.