Benefits Claims Specialist - Impactful Health Coverage

CVS Health; Franklin (TN); In loco; USD 23.000 - 39.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental & vision coverage

Paid time off

Retirement savings options

Wellness programs

Descrizione del lavoro

CVS Health in Franklin, TN seeks a full-time Claims Processor to review Benefits claims, verify coverage, and communicate with providers and patients. You will document data in the system, ensure accuracy, and support timely processing of reimbursements.

Ideal candidates have 1+ year customer service experience, strong problem solving, and the ability to multitask in a production environment. Eligible benefits include medical, dental, vision, PTO and retirement savings; pays $17.00–$28.46 per

Competenze

• 1+ year working experience in a customer service environment.
• Strong problem solving and decision making skills.

Mansioni

• Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
• Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
• Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
• Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
• Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
• Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.
• Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.
• Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
• Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.

Conoscenze

Customer service

Problem solving

Formazione

High school diploma

Descrizione del lavoro

CVS Health in Franklin, TN seeks a full-time Claims Processor to review Benefits claims, verify coverage, and communicate with providers and patients. You will document data in the system, ensure accuracy, and support timely processing of reimbursements.

Ideal candidates have 1+ year customer service experience, strong problem solving, and the ability to multitask in a production environment. Eligible benefits include medical, dental, vision, PTO and retirement savings; pays $17.00–$28.46 per