Senior Claims Benefit Specialist - Remote

Overview

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

In Short

• Reviews and adjudicates complex, sensitive, and/or specialized claims.
• Acts as a subject matter expert by providing training and coaching.
• Handles customer service inquiries and problems.
• Applies medical necessity guidelines and determines coverage.
• Completes eligibility verification and identifies discrepancies.
• Ensures compliance requirements are satisfied.
• Identifies and reports possible claim irregularities.
• Distributes work assignments to junior staff.
• Trains and mentors claim benefit specialists.
• Makes outbound calls for required information.

Requirements

• 2+ years medical claim processing experience.
• Experience in a production environment.
• Demonstrated ability to handle multiple assignments competently.
• Self-Funding experience preferred.
• DG system knowledge preferred.
• High School Diploma required.
• Preferred Associates degree or equivalent work experience.

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan available.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Numerous well-being programs and education assistance.
• Paid Time Off (PTO) and paid holidays.