Supervisor, Adjudication OCR
CVS Health
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.
**Position Summary**
**THIS IS AN EVENING SHIFT - 11:30am-8pm PST**
Supervisor will be responsible for the day-to-day oversight of the third-party adjudication team. This role will service as the lead claims adjudicator, provide appropriate scheduling to ensure shift coverage, research and resolve escalated claim issues, and oversee adjudicators performance including metrics and training.
Responsible for preparing and submitting claims for accounts to ensure timely reimbursement of claims. Third-Party Billing works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims.
**Required Qualifications**
+ 3 or more years’ experience as successful claims biller/supervisor experience preferably in a Fortune 500 company
+ Must have strong knowledge of billing and healthcare claim issues
+ Demonstrates core competencies of leadership, planning and execution, solution oriented, strong communication skills, collaborative business partner
+ Advanced to expert skills in Excel/Access and able to effectively analyze large quantity of data
+ Perform multiple tasks effectively
**Preferred Qualifications**
+ Past industry-related experience preferred
+ Pharmacy technician certification highly preferred
+ Experience in pharmacy, managed care, Medicaid and/or Medicare organizations
**Education**
High School Diploma or General Equivalent Development (GED)
**Pay Range**
The typical pay range for this role is:
$43,888.00 - $93,574.80
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.
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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 01/31/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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