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
This position is primarily supporting Aetna International's specialized line of business where international clients send members to US providers for care and international members living in the US. This individual will engage with the top US hospital systems international departments to ensure streamlined processes for our members and be an advocate for the client, member, and Aetna.
This individual will work independently and be accountable to handle a variety of activities including educating providers on our line of business, engaging in contract and claim review, facilitating detailed claims reconciliations as issues arise, analyzing complex provider reporting, negotiating one time letters of agreement, presenting to external clients overview of our network capabilities.
The position is hybrid and being hired either out of New York City, NY or Fort Lauderdale, FL area; this means the individual will go into the office regularly either to the New York City, NY or Plantation, FL office. There will be some local ad hoc domestic travel to large health systems based on the individual's location.
Position Responsibilities
Establishes relationships with network providers, fostering open communication and collaboration to ensure a strong network partnership.
Addresses and resolves escalated issues and concerns raised by network providers, demonstrating a proactive and customer-centric approach to problem-solving.
Collaborates to negotiate and establish contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.
Collaborates with cross-functional teams, such as finance, operations, and customer service, to ensure effective coordination and alignment of network-related activities and initiatives.
Conducts regular meetings and performance reviews with network providers to review performance metrics, address concerns, and identify opportunities for improvement.
Stays updated on industry trends, regulatory changes, and market dynamics that may impact network provider relationships, and proactively communicates relevant information to internal stakeholders.
Required Qualifications
- 2-3 years claims processing experience to support provider specific questions, reconciliations, and understand claims rules.
- 2-3 years contract building
- 2-3 years provider relations
- Excellent internal and external communication stills.
- Handling VVIP client expectations in timely and professional manner.
- Experience in internal systems to update and review provider insurance contracts.
- Ability to work hybrid 2 to 3 days a week in either the New York 101 Park Ave. or the Plantation 261 University Dr. Florida. office.
Preferred Qualifications
- Aetna specific medical claim processing experience.
- Aetna specific provider contract setup experience.
Education
- Bachelor's degree preferred/specialized training/relevant professional qualification.
- Prior Relevant Work Experience 5-7 years
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,300.00 - $159,120.00
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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
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No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
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Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 05/25/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Top Skills
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners.
Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
