Complex Reinsurance & Stoploss Claims Adjuster

Internationalinsuranceprofessionals; Atlanta (GA); Vor Ort; USD 26.000 - 58.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Zusammenfassung

CVS Health in the United States is seeking a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, collaborating with key business functions to ensure accuracy and resolve discrepancies.

The role handles high-dollar claims, applies medical necessity guidelines, processes inquiries and pre-authorizations, and ensures compliance while delivering customer service. This is a full-time position with comprehensive benefits.

Qualifikationen

• 2+ years of medical claim processing experience.
• 2+ years in a production environment.
• Familiarity with Reinsurance/Stop loss medical claims.
• Ability to handle multiple assignments competently, accurately, and efficiently.

Aufgaben

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Apply medical necessity guidelines and determine coverage.
• Perform claim re-work calculations and reconcile discrepancies.
• Handle inquiries related to pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and proper payments according to procedures.

Kenntnisse

Medical claim processing

Production environment experience

Customer service

Ausbildung

Associate degree or equivalent experience

Tools

DG system claims processing

Jobbeschreibung

CVS Health in the United States is seeking a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, collaborating with key business functions to ensure accuracy and resolve discrepancies.

The role handles high-dollar claims, applies medical necessity guidelines, processes inquiries and pre-authorizations, and ensures compliance while delivering customer service. This is a full-time position with comprehensive benefits.