Senior Claims Benefit Specialist - Remote

Overview

As a Senior Claims Benefit Specialist at CVS Health, you will play a crucial role in reviewing and adjusting various claims while ensuring compliance with company guidelines. This position allows you to contribute to transforming healthcare by providing compassionate service to our customers.

In Short

• Review and adjust self-funded and fully insured claims.
• Adjudicate complex and sensitive claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries related to claims.
• Apply medical necessity guidelines and determine coverage.
• Perform claim re-work calculations and adjustments.
• Ensure compliance with all payment practices.
• Provide job shadowing to less experienced staff.
• Utilize resource materials to manage responsibilities effectively.
• Collaborate with team members to enhance service delivery.

Requirements

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Demonstrated ability to handle multiple assignments efficiently.
• Effective communication and organizational skills.
• Preferred: DG system claims processing experience.
• Preferred: Associate degree.
• High School Diploma or GED required.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching contributions.
• Employee stock purchase plan.
• No-cost wellness programs and counseling services.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave options.
• Comprehensive benefits addressing diverse needs.