Description
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. *Job Purpose and Summary:* Aetna Long-Term Care (LTC) administers a closed block of 50,000 policies and claims. LTC refers to range of services designed to support the needs of people living with chronic health problems that affect their ability to perform everyday activities. The position serves an integral role in supporting Aetna LTC's consistent delivery of timely and accurate claims management and quality customer service for our members. This position is responsible for supporting consistent delivery of timely and accurate claims management and quality customer service for Aetna LTC members. Effectively collaborates with Claims Analysts, Claim Managers, RN Case Managers, Care Claims Consultant, and Director, along with care providers, and external partners and customers. This position is responsible for ensuring timely and accurate claim payments and quality customer service through timely and accurate completion of appropriate activities including: * Review and distribute incoming documents received in the LTC Claim Box, LTC Fax Box, and Ricoh Team Box; * Accurately complete registration and assignment of Benefit Request Forms (new claims); * Research and respond to HMS (Medicaid) inquiries; * Process Return of Contributions; * Gather information needed to respond to requests for Benefits Summaries and Explanation of Benefits (EOB) Forms; * Complete death claim processing and related follow-ups; * Review and update diverse claim follow-up activities and documentation; * Process requests to initiate Electronic Fund Transfer and Assignment of Benefits; * Assist with claim overpayment processing and related follow-up activities; * Assist with LCP functions including, but not limited to, LCP Call Center and LCP/LTC imaging; * Generate benefit exhaust correspondence and related claim documentation; * Provide accurate and timely communications within prescribed policies, procedures, regulations, and service metrics. * Collaborate effectively with fellow LTC/LCP team members, along with internal and external partners. * Enter information and utilize multiple computer systems, programs, and databases; . Primary Job Duties & Responsibilities: * Analyze and distribute incoming items in LTC Claim Box, LTC Fax Box, and Ricoh Team Box - 40% * Assess Benefit Request Forms (BRF) and register and assign new claims - 25% * Research and respond to HMS (Medicaid) and Payment History Requests and Process Return of Contributions (ROC) - 10% * Support diverse LTC and LCP functions to ensure timely delivery of quality member services - 25 *Education:* * High School Diploma or General Equivalent Development (GED) or equivalent experience required * Associates Degree or Bachelor Degree preferred *Preferred Qualification:* * 2-4 years LTC, disability, and/or customer service experience preferred. * Knowledge of Microsoft Office Tools including Word and Excel Skilled In:* * * Demonstrating a positive team approach to serving customers. * Embracing change in a continuous improvement team culture. Ability To: * Demonstrated ability to effectively prioritize and execute diverse tasks with high degree of accuracy and timeliness * Organized and conscientious with strong follow-through * Proven proactive, positive, collaborative team player and problem solver * Demonstrated success working in a multi-system (i.e., both mainframe and Windows) environment * Proven success communicating verbally and in writing with both external customers and internal business partners * Experience gathering and explaining complex information * Strong financial and general business acumen * Ability to effectively work independently and as and engaged member of a collaborative team * Demonstrated commitment to continuously improving operational efficiency and effectiveness * Eagerness and ability to learn quickly and to embrace change * Demonstrated regular and predictable attendance * Willingness to take on additional tasks as assigned by Director. Our diverse work experience empowers colleagues for career success. In addition to skill and experience, we attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability. CVS Health is an equal opportunity/affirmative action employer. *Pay Range* The typical pay range for this role is: $17.00 - $29.88This 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](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 05/17/2024
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