Medical Reinsurance & Stoploss Claims Specialist

CVS Health; Fulton (MS); Presencial; USD 25.000 - 58.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonus/incentive program

Comprehensive benefits

Descripción de la vacante

CVS Health is seeking an experienced Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims and adjudicate high-dollar cases in line with processing guidelines.

You will collaborate with cross-functional teams to ensure accuracy in adjustments, respond to customer inquiries, and help resolve rework discrepancies while adhering to compliance requirements. This full-time role offers competitive benefits.

Formación

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

Responsabilidades

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Adjudicate high-dollar complex claims per processing guidelines.
• Collaborate with key business functions to ensure accuracy in adjustments.
• Handle customer inquiries and concerns.
• May deliver claim adjustment training and mentor staff.

Conocimientos

Medical claim processing

Production environment

Educación

Associate degree or equivalent experience

Descripción del empleo

CVS Health is seeking an experienced Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims and adjudicate high-dollar cases in line with processing guidelines.

You will collaborate with cross-functional teams to ensure accuracy in adjustments, respond to customer inquiries, and help resolve rework discrepancies while adhering to compliance requirements. This full-time role offers competitive benefits.