Easter Seals Jobs

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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

Support Aetna's ability to achieve its financial and strategic goals through effective underwriting. Underwriting support primarily includes identifying, evaluating, and managing risk in order to maximize revenue, membership and earnings.

Performs underwriting analysis and risk assessment for new and/or renewal of large group contracts. Collaborates with underwriting teams to review large claims for future cost projections based on diagnosis/prognosis.

Provides consulting and clinical review of medical Underwriter’s cases. Approves or denies requests, assesses claim range appropriateness. Performs clinical audits as required; provides feedback to educate underwriters on various disease processes. Engages in underwriting decisions with significant benefit implications.

Collaborates with the underwriting team, account management to discuss case related activity.

Assesses risks and makes underwriting recommendations based on established criteria and/or medical judgments. Handles casework and issues using solid knowledge of Aetna’s products, services and underwriting protocols.

Researches medical Underwriting guidelines and claim risk criteria.

Provides support for appeals and advises management and staff of unusual situations.

Participates in project work groups including process improvement initiatives.

Analyzes trends in claim experience.

Conducts analysis of autopsy, police reports, and medical records for rationale for claims and assists in making financial risk decisions.

This is an individual contributor role

Required Qualifications

Bachelor’s degree or equivalent experience

Minimum 3+ years of relevant work experience

Must be a current Registered Nurse

Must have Strong/high technical skills (Microsoft products; Excel, Word, QuickBase, etc)

Must be an analytical clinician with sound understanding of underwriting risk assumptions.

Ability to work independently

Preferred Qualifications

3 - 5 years of experience in medical underwriting and risk assessment.

High-cost conditions knowledge is preferred

Education

Bachelor's degree or equivalent experience

Active Registered Nurse certification

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

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.

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: 03/14/2025

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.