Claims Benefit Specialist: Elevate Member Care

CVS Health; Boston (MA); On-site; USD 23,000 - 47,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Paid time off

Retirement plan

Job summary

CVS Health in the United States is seeking a Claims Benefit Specialist to review and adjudicate medical claims in line with processing guidelines. This role provides accurate, timely resolution aimed at high member satisfaction and retention, contributing to a smooth claims experience for customers.

The position requires detail orientation, teamwork, and the ability to master multiple systems. Attendance during a 21-week training period is required, with potential overtime after training based

Qualifications

• Experience in a quality and production environment.
• Attention to detail.
• Ability to use multiple computer applications at one time.

Responsibilities

• Determine and understand the coverage provided under a member's health plan.
• Efficiently use multiple systems and screens to obtain and record claim information.
• Review claims information to determine the nature of a member's illness or injury.
• Identify claim cost management opportunities and refer claims for follow up.
• Make claim payment decisions.
• Process claims accurately to enhance customer satisfaction and retention.
• Process claims within quality and production standards.
• Assist team members in support of achieving team, office, regional, and national goals.

Skills

Attention to detail

Experience in a quality and production

Ability to use multiple computer apps

Education

High School Diploma or GED

Associate's Degree

Job description

CVS Health in the United States is seeking a Claims Benefit Specialist to review and adjudicate medical claims in line with processing guidelines. This role provides accurate, timely resolution aimed at high member satisfaction and retention, contributing to a smooth claims experience for customers.

The position requires detail orientation, teamwork, and the ability to master multiple systems. Attendance during a 21-week training period is required, with potential overtime after training based