If you’re the “find the leak, fix the system” type, this role is built for you. You’ll manage claim data end-to-end, improve auto-adjudication accuracy, and dig into trends using advanced Excel (pivot tables, reporting) while supporting Medicaid and Medicare claim platforms.
About CVS Health (Aetna Better Health of Oklahoma)
Aetna Better Health of Oklahoma, a CVS Health company, supports Oklahoma communities with services designed to improve wellness and everyday life for members. This team focuses on accurate claim handling, stronger auto-adjudication performance, and clean data that keeps the whole operation running right.
Schedule
- Fully remote (must reside in Oklahoma)
- Full-time: 40 hours per week
- Travel up to 10% (primarily to the Oklahoma City office)
- Application window expected to close December 23, 2025
What You’ll Do
⦁ Handle end-to-end claim data management and resolve issues impacting auto-adjudication and claim accuracy
⦁ Review claims that exceed standard adjudication authority or require advanced processing expertise
⦁ Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and apply cost containment measures
⦁ Handle phone and written inquiries related to pre-authorizations, reconsiderations, and appeals
⦁ Ensure compliance requirements are met and payments align with company practices and procedures
⦁ Identify and report potential overpayments, underpayments, and other claim irregularities
⦁ Perform claim rework calculations and make outbound calls to obtain required claim information
⦁ Review and submit requests for auto-adjudication improvements
⦁ Analyze trends, denial reporting, and project outcomes, including reporting financial impact of completed work
⦁ Support manual plan setup for new business/account implementations when needed
What You Need
⦁ Must reside in Oklahoma (full-time teleworker role)
⦁ 1+ year experience in healthcare and/or medical customer service
⦁ 2+ years of claim processing experience, including proficiency with Medicaid and/or Medicare claim platforms/products
⦁ 2+ years of experience navigating multiple systems and using Microsoft Office (Teams, Outlook, Word, Excel)
⦁ Advanced Excel skills, including creating reports and pivot tables
⦁ High school diploma or GED
⦁ Ability to travel up to 10% primarily to Oklahoma City
Benefits
⦁ Pay range: $18.50 to $31.72 (varies by experience, location, and qualifications)
⦁ Eligible for bonus, commission, or short-term incentive programs (in addition to base pay)
⦁ Affordable medical plan options and 401(k) with company match
⦁ Employee stock purchase plan eligibility
⦁ No-cost wellness programs plus confidential counseling and financial coaching
⦁ Paid time off, flexible schedules, family leave, tuition assistance, and other benefits based on eligibility
This posting is expected to close December 23, 2025. If you’re in Oklahoma and you’ve got the Medicaid/Medicare claims chops plus strong Excel, this is a real step up.
One honest note: this role is more “analyst-brained” than “call center.” If you like patterns, pivots, and fixing root causes, it’ll feel good.
Happy Hunting,
~Two Chicks…