Reinsurance & Stoploss Claims Specialist

CVS Health; Nebraska; In loco; USD 25.000 - 58.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical benefits

Dental benefits

Vision benefits

Retirement plan

Descrizione del lavoro

CVS Health is hiring for a Reinsurance/Stoploss Claims Adjuster role. You will review and adjust complex medical claims, determine coverage, and verify eligibility while ensuring compliance with processing guidelines.

Position requires at least 2 years of medical claim processing experience in a production setting, with strong attention to detail and effective communication with stakeholders.

Competenze

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

Mansioni

• Review, research, and adjust complex Reinsurance/Stoploss medical claims across dollar amounts.
• Apply medical necessity guidelines and determine coverage, verify eligibility, and identify discrepancies.

Conoscenze

Medical claim processing

Claims adjudication

Communication skills

Formazione

Associate degree or equivalent experience

Descrizione del lavoro

CVS Health is hiring for a Reinsurance/Stoploss Claims Adjuster role. You will review and adjust complex medical claims, determine coverage, and verify eligibility while ensuring compliance with processing guidelines.

Position requires at least 2 years of medical claim processing experience in a production setting, with strong attention to detail and effective communication with stakeholders.