Reinsurance & Stoploss Claims Specialist

CVS Health; Trenton (NJ); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Eligibility-based benefits details

Job summary

CVS Health in New Jersey is seeking a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, splitting claims into multiple statuses and adjudicating high-dollar cases. You will collaborate across teams to ensure accuracy in adjustments and respond to customer inquiries.

Ideal candidates have 2+ years of medical claim processing and production experience, with a focus on accuracy, efficiency, and compliance.

Qualifications

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

Responsibilities

• Review and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions for accurate claim adjustments.
• Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and that all payments follow company practices.
• May deliver training or mentorship to less experienced staff.

Skills

Medical claim processing

Production environment

Education

Associate degree

Job description

CVS Health in New Jersey is seeking a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, splitting claims into multiple statuses and adjudicating high-dollar cases. You will collaborate across teams to ensure accuracy in adjustments and respond to customer inquiries.

Ideal candidates have 2+ years of medical claim processing and production experience, with a focus on accuracy, efficiency, and compliance.