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CVS HealthPosted 10/19/2026full-timeRemote • Connecticut • United StatesLead💰 $174,070 - $374,920 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates clinical expertise in health care delivery and payment policy, with a strong focus on clinical coding, reimbursement, and quality improvement. Proven ability to collaborate with diverse teams and provide subject matter expertise to enhance health care quality and efficiency.
Highest-signal resume keywords
Clinical ExpertiseClinical Coding (HCPCS/CPT)Health PolicyActive Medical LicenseBoard Certification
About the role
Key responsibilities & impact- Provide clinical expertise to promote high-quality, constituent-focused medical care, with a focus on clinical and payment policy
- Conduct transactional reviews supporting the appeal process
- Perform clinical claim reviews
- Conduct predetermination of covered benefits in Commercial and Medicare environments
- Provide subject matter expertise in clinical and payment policy to support clinical and business direction
- Participate in work groups as a clinical subject matter expert to identify and promote opportunities to improve health care quality and efficiency
- Apply clinical coding and reimbursement expertise to ensure correct application of Aetna policies and practices to service and payment requests
- Use data analysis to identify quality improvement opportunities and positively influence delivery of quality care services
- Serve as a subject matter expert, internal consultant and payment policy contributor
- Work within and lead diverse teams of health delivery professionals to manage company business objectives
- Collaborate with functional areas
Requirements
What you’ll need- At least one year of experience employed within a health insurance company
- Five (5) or more years of experience in a health care delivery system, such as clinical practice, and the health care industry
- Active and current state medical license without encumbrances
- M.D. or D.O.
- Board Certification in an ABMS recognized specialty
- Post-graduate direct patient care experience
- Foundational baseline skills in medicine, health policy, coding (HCPCS/CPT), clinical policy, reimbursement and health care systems
- Strong written and verbal communication skills
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program
- Equity award program
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Claim ReviewsData AnalysisReimbursement ExpertisePredetermination of Covered BenefitsQuality Improvement
Soft Skills
Strong Written CommunicationStrong Verbal Communication
Certifications & Qualifications
M.D.D.O.Board Certification in ABMS Specialty
Industry Keywords
Health InsuranceHealth Care Delivery SystemClinical PracticePayment PolicyHealth Care Systems