Benefits Claims Specialist: Data-Driven Impact

4062 Aetna Resources, LLC; Arizona; On-site; USD 23,000 - 39,000; Full time

Job summary

CVS Health is hiring for a claims processing role in the United States. The position involves reviewing and processing medical claims, verifying policy coverage and coding accuracy, and communicating with providers and patients to resolve issues.

You will ensure compliant handling, accuracy, and timely processing, with opportunities to analyze data trends and support improvements in the claims department. 40 hours weekly, full-time, with comprehensive benefits.

Qualifications

• 1–2 years’ experience in healthcare.
• Strong teamwork and organizational skills.
• Effective communication abilities.
• Ability to manage multiple tasks with prioritization.
• Proficient computer use and data-entry experience.

Responsibilities

• Handles and processes benefits claims submitted by healthcare providers.
• Determines eligibility and coverage of benefits for each claim.
• Assesses claims for accuracy and compliance with coding guidelines.
• Documents claim information in the company system with codes and data elements.
• Conducts reviews and investigations of claims requiring additional validation.
• Communicates with healthcare providers, patients or stakeholders to resolve discrepancies.
• Ensures processing complies with regulations, standards and policies.
• Participates in feedback and performance review processes to improve service and engagement.
• Analyzes claims data to identify trends and process improvements.

Skills

Healthcare experience

Teamwork

Communication skills

Time management

Data entry

Education

High School diploma or GED

Job description

CVS Health is hiring for a claims processing role in the United States. The position involves reviewing and processing medical claims, verifying policy coverage and coding accuracy, and communicating with providers and patients to resolve issues.

You will ensure compliant handling, accuracy, and timely processing, with opportunities to analyze data trends and support improvements in the claims department. 40 hours weekly, full-time, with comprehensive benefits.