Complex Reinsurance & Stop-Loss Claims Specialist

CVS Health; Montana City (MT); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Job summary

CVS Health is seeking a dedicated Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims. You will split claims into proper statuses, apply guidelines, and collaborate with teams to ensure accuracy in adjustments and pricing.

The role handles high-dollar, sensitive claims, assists with inquiries, and ensures compliance with company practices. Eligible for comprehensive benefits with a full-time schedule.

Qualifications

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

Responsibilities

• Review and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries related to pre-approvals, reconsiderations, or appeals.
• Ensure compliance and proper payments according to company policies.
• May mentor junior staff and deliver training on claim adjustments.

Skills

Medical claim processing

Production environment

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Reinsurance/Stop loss familiarity

Job description

CVS Health is seeking a dedicated Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims. You will split claims into proper statuses, apply guidelines, and collaborate with teams to ensure accuracy in adjustments and pricing.

The role handles high-dollar, sensitive claims, assists with inquiries, and ensures compliance with company practices. Eligible for comprehensive benefits with a full-time schedule.