Complex Reinsurance & Stop-Loss Claims Adjuster

CVS Health; Arkansas; On-site; USD 26,000 - 58,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health is seeking a detail-oriented Adjuster to review and adjust complex Reinsurance/Stoploss medical claims. You will split claims into multiple statuses and adjudicate high-dollar, complex cases in line with guidelines.

You will collaborate across departments to ensure accuracy and resolve rework discrepancies while addressing customer inquiries. The role requires 2+ years in medical claim processing and a background in a production setting.

Qualifications

• 2+ years medical claim processing experience.
• 2+ years experience in a production environment.

Responsibilities

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries and concerns.
• Perform claim adjustments across all dollar amounts using claims processing expertise.
• Follow compliance requirements and ensure payments align with company procedures.
• May deliver training or mentor junior staff.

Skills

Medical claim processing

Production environment

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a detail-oriented Adjuster to review and adjust complex Reinsurance/Stoploss medical claims. You will split claims into multiple statuses and adjudicate high-dollar, complex cases in line with guidelines.

You will collaborate across departments to ensure accuracy and resolve rework discrepancies while addressing customer inquiries. The role requires 2+ years in medical claim processing and a background in a production setting.