Senior trainer - special investigations claims, CVS Health

CVS Health

Location:
United States, Work at Home

Category:
-

Contract Type:
Employment contract

Salary:

21.10 - 40.90 USD / Hour

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Job Description:

Senior Trainer who will support the Special Investigations team will design, develop, and deliver detailed curriculum and subsequent training sessions to company-designated audiences of learners in the Claims area at CVS Health

Job Responsibility:

Design, develop, and deliver detailed curriculum and subsequent training sessions to company-designated audiences of learners in the Claims area
Independently oversee and lead the virtual environment for long-term and complex training situations, managing all aspects of student performance and feedback to management
Coach, mentor, and oversee others in both technical and behavioral skills for development purposes
Provide Coordinators the training and support and reviewing claims for potential acts of healthcare fraud and abuse by both members and providers
Provide direction and counsel on the handling of claims and facilitates issue resolution
Ensure compliance with Federal and State Fraud mandates
Maintain a positive organizational climate
Collaborate with compliance and senior leadership
Contribute to the development and delivery of educational awareness and training programs that meet or exceed those required by state mandates
Update and maintain the SIU Prevention team Hub
Review and respond to all Quality first audit rebuttals

Requirements:

2+ years claim processing experience
Knowledge of Insurance Systems (eg. HRP, MedCompass, ACAS, ECHS)
Strong verbal and written communication skills
Ability to interact with different groups of people at different levels and provide assistance on a timely basis
Ensures delivery of quality services
Microsoft Office product and QuickBase proficiency
High School Degree

Nice to have:

Experience with systems like ACAS and ECHS
Experience with delivering customer service to Aetna personnel, outside law enforcement agencies, and vendors with courtesy, empathy, sense of urgency and sensibility to the situation
Experience with healthcare fraud, waste and abuse
Demonstrated ability to handle multiple assignments competently, accurately, and efficiently

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 01, 2025

Expiration:
October 10, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior trainer - special investigations claims