At CVS Health (Aetna), I audit complex medical claims to identify overpayments, payment discrepancies, billing errors, and recovery opportunities.
I use HealthRules Payor, healthcare claims systems, and Microsoft Excel to investigate claims, reconcile large datasets, validate payment accuracy, and document audit findings that support payment determinations.
After beginning as a Claims Benefit Specialist, I was promoted to Payment Integrity based on my performance and analytical ability. I independently manage high-volume work in a fully remote environment while meeting quality, productivity, compliance, and documentation standards.
