Healthcare Claims Benefit Specialist - Remote Training

CVS Health; United States; Remote; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Claim Benefit Specialist to support claims processing and adjudication. The role includes applying medical necessity guidelines, verifying eligibility, and resolving discrepancies with providers and patients.

Training is provided virtually for 20 weeks, with a 40-hour weekly schedule. Responsibilities include reviewing and adjudicating claims, ensuring compliance with guidelines, and generating reports to guide process improvements.

Qualifications

• 1-2 years experience working in Customer Service.
• Strong teamwork and organizational skills.
• Strong and effective communication skills.
• Ability to handle multiple assignments competently through use of time management, accurately and efficiently.

Responsibilities

• Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
• Determines the eligibility and coverage of benefits for each claim based on the patient’s insurance plan and policy guidelines and scope.
• Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
• Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
• Communicates with healthcare providers, patients, or other stakeholders to resolve discrepancies or issues related to claims.
• Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.

Skills

Customer service

Teamwork

Communication

Time management

Education

High School diploma

Job description

CVS Health is seeking a Claim Benefit Specialist to support claims processing and adjudication. The role includes applying medical necessity guidelines, verifying eligibility, and resolving discrepancies with providers and patients.

Training is provided virtually for 20 weeks, with a 40-hour weekly schedule. Responsibilities include reviewing and adjudicating claims, ensuring compliance with guidelines, and generating reports to guide process improvements.