Complex Reinsurance & Stoploss Claims Specialist

CVS Health; Cheyenne (WY); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a seasoned Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, collaborating with multiple teams to ensure accurate adjudication and compliant processing. You will also handle related inquiries and support process improvements.

The role requires 2+ years in medical claims processing and an Associate degree or equivalent. This full-time on-site position offers a competitive pay range, comprehensive benefits, and potential bonus

Qualifications

• 2+ years in medical claim processing.
• 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 adjustments.
• Handle inquiries related to pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and that payments follow company procedures.
• May mentor less experienced team members.

Skills

Medical claim processing

Production environment

Reinsurance/Stoploss claims

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a seasoned Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, collaborating with multiple teams to ensure accurate adjudication and compliant processing. You will also handle related inquiries and support process improvements.

The role requires 2+ years in medical claims processing and an Associate degree or equivalent. This full-time on-site position offers a competitive pay range, comprehensive benefits, and potential bonus