Reinsurance & Stop-Loss Claims Specialist

Internationalinsuranceprofessionals; Baton Rouge (LA); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Job summary

CVS Health is seeking a Reinsurance/Stoploss Claims Adjuster to review and adjust complex medical claims with precision. You will collaborate with cross-functional teams to ensure accurate claim adjustments and resolve customer inquiries.

The role emphasizes adherence to guidelines, handling rework, and applying medical necessity and cost containment measures, while ensuring compliance and high-quality service for patients and providers.

Qualifications

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

Responsibilities

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries and concerns.
• Follow through completion of claim adjudication and rework.
• Utilize provider contracts to verify overpayments/underpayments.

Skills

Medical claims processing

Production environment

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a Reinsurance/Stoploss Claims Adjuster to review and adjust complex medical claims with precision. You will collaborate with cross-functional teams to ensure accurate claim adjustments and resolve customer inquiries.

The role emphasizes adherence to guidelines, handling rework, and applying medical necessity and cost containment measures, while ensuring compliance and high-quality service for patients and providers.