Ohio Staffing
Provider Advocate
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. Meritain Health provides customized benefits, cost management, and network access for millions of members. The Provider Advocate will work within Meritain, primarily with providers and claims. This person oversees various relationships with Meritain's high-profile groups and handles any relevant escalations as needed. Position Summary: Resolves provider and network inquiries and escalations. Serves as single point-of-contact for network high utilization providers. Coordinates provider projects for mass adjustments and payment verifications to include client reimbursements or settlements. Attends and participates in daily dedicated Claims Touchpoint calls, specific to addressing complex provider concerns. Works on escalation projects through internal and external partnership. Works on internal and network project requests for appropriate resolution in a timely manner. Ensures all tickets and projects are completed with attention to detail and accuracy. Owns several projects from start to finish. Performs other duties as assigned. Required Qualifications: 2+ years of healthcare industry experience, specifically in provider relations. Demonstrated proficiency with Microsoft Office Suite, particularly Microsoft Excel. Preferred Qualifications: Previous experience with Salesforce. Previous experience in claim adjudication. Strong data logic efficiency. Ability to effectively communicate findings to the submitter and other internal departments. Excellent organizational skills. High-level analytical skills. Problem solving and project improvement skills. High comfort level with presenting case findings in meetings with upper leadership. Associate's or Bachelor's degree. Education: High school diploma or GED. Anticipated Weekly Hours: 40 Time Type: Full time Pay Range: The typical pay range for this role is: $46,988.00 - $122,400.00 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: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. 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. 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.
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. Meritain Health provides customized benefits, cost management, and network access for millions of members. The Provider Advocate will work within Meritain, primarily with providers and claims. This person oversees various relationships with Meritain's high-profile groups and handles any relevant escalations as needed. Position Summary: Resolves provider and network inquiries and escalations. Serves as single point-of-contact for network high utilization providers. Coordinates provider projects for mass adjustments and payment verifications to include client reimbursements or settlements. Attends and participates in daily dedicated Claims Touchpoint calls, specific to addressing complex provider concerns. Works on escalation projects through internal and external partnership. Works on internal and network project requests for appropriate resolution in a timely manner. Ensures all tickets and projects are completed with attention to detail and accuracy. Owns several projects from start to finish. Performs other duties as assigned. Required Qualifications: 2+ years of healthcare industry experience, specifically in provider relations. Demonstrated proficiency with Microsoft Office Suite, particularly Microsoft Excel. Preferred Qualifications: Previous experience with Salesforce. Previous experience in claim adjudication. Strong data logic efficiency. Ability to effectively communicate findings to the submitter and other internal departments. Excellent organizational skills. High-level analytical skills. Problem solving and project improvement skills. High comfort level with presenting case findings in meetings with upper leadership. Associate's or Bachelor's degree. Education: High school diploma or GED. Anticipated Weekly Hours: 40 Time Type: Full time Pay Range: The typical pay range for this role is: $46,988.00 - $122,400.00 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: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. 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. 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.