Reinsurance & Stoploss Claims Specialist

CVS Health; Nashville (TN); Vor Ort; USD 25.000 - 58.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Zusammenfassung

CVS Health is seeking a Claims Adjuster for Reinsurance/Stoploss to review and adjust complex medical claims, ensuring accuracy and compliance. You will collaborate with multiple teams, handle inquiries, and apply cost-containment measures to guidance, supporting high-dollar claims processing.

This full-time role requires 2+ years in medical claim processing and familiarity with Reinsurance/Stop loss concepts, with strong attention to detail and communication skills.

Qualifikationen

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

Aufgaben

• Review, research, and adjust complex Reinsurance/Stoploss medical claims across dollar levels.
• Collaborate with key functions to ensure accuracy in claim adjustments and reconcile rework discrepancies.
• Handle customer inquiries related to pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and that payments follow company practices.

Kenntnisse

Medical claim processing

Production environment

Communication

Attention to detail

Ausbildung

Associate degree or equivalent experience

Tools

DG system

Jobbeschreibung

CVS Health is seeking a Claims Adjuster for Reinsurance/Stoploss to review and adjust complex medical claims, ensuring accuracy and compliance. You will collaborate with multiple teams, handle inquiries, and apply cost-containment measures to guidance, supporting high-dollar claims processing.

This full-time role requires 2+ years in medical claim processing and familiarity with Reinsurance/Stop loss concepts, with strong attention to detail and communication skills.