Provider Data Service Specialist – Fully Remote

May 9, 2024

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Job 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.
Position Summary
Provides operational support and performs data maintenance and clean-up for data transactions (basic to complex). In addition, performs data transactions and maintenance associated with projects, expansions, and new product implementations. Works with other departments to ensure quality provider data to our members.
Additional Duties
– Maintains and updates provider demographic and contract information, including contractually sensitive or complex transactions, in appropriate systems in support of claims adjudication and provider directory.
– Works collaboratively with internal/external constituents to implement new networks and complex contractual arrangements.
– May provide technical and/or functional leadership within unit (i.e., team lead).
– Performs validation of system enhancements.
– Identifies, researches and conducts root cause analyses (e.g. problem providers identified by PST, trends from routine PDS audits) and collaborates cross-functionally within the organization to recommend process improvements.
– Conducts and manages audits of provider information and escalates issues for resolution as appropriate.
Required Qualifications
– 1-2 years experience claims experience (Medical, Dental or Auto Claims)
– 1-2 years of claims and/ or healthcare terminology knowledge.
– Demonstrated ability to handle multiple assignments.
– Demonstrated Ability to work in a production environment
– Proficient in Microsoft Office Applications with Advanced skills in Excel.
– Demonstrated success prioritizing work and the ability to multi-task in a fast paced environment.
– Demonstrated success in collaborating with others to meet/exceed expectations.
– Experience providing clear and concise written and verbal communications
Preferred Qualifications
– EPDB experience
– Associate’s degree or equivalent work experience.
Pay Range
The typical pay range for this role is:
$17.00 – $29.88
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.
For more detailed information on available benefits, please visit
We anticipate the application window for this opening will close on: 05/20/2024

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