Reinsurance & Stoploss Claims Specialist

CVS Health; Carson City (NV); On-site; USD 26,000 - 58,000; Full time

Job summary

CVS Health, a leading healthcare company, is seeking a Reinsurance/Stoploss Claims Adjuster to review and adjust complex claims. You will collaborate with multiple teams to ensure accuracy in adjustments, process inquiries, and adhere to compliance guidelines.

Ideal candidates have 2+ years in medical claims processing and experience in a production environment. This full-time role offers comprehensive benefits and growth opportunities within CVS Health.

Qualifications

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

Responsibilities

• Review and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with business functions to ensure accuracy in claim adjustments.
• Handle inquiries related to pre-approvals, reconsiderations, or appeals.
• Ensure compliance and correct payment processing.
• Mentor less experienced team members where needed.
• Research and resolve discrepancies in rework and over-/underpayments.

Skills

Claim processing

Production environment

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health, a leading healthcare company, is seeking a Reinsurance/Stoploss Claims Adjuster to review and adjust complex claims. You will collaborate with multiple teams to ensure accuracy in adjustments, process inquiries, and adhere to compliance guidelines.

Ideal candidates have 2+ years in medical claims processing and experience in a production environment. This full-time role offers comprehensive benefits and growth opportunities within CVS Health.