Remote Senior Medical Claims Specialist – Adjudication Expert

CVS Health; Utah; Híbrido; USD 25.000 - 58.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Descripción de la vacante

CVS Health is seeking a full-time Medical Claims Adjudication Specialist in Utah. You will review and adjudicate complex medical claims, coach peers, and support customer service by resolving issues to enhance member experience.

The role requires at least 18 months of medical claim processing experience, strong attention to detail, and the ability to handle multiple priority tasks in a high-volume setting. Excellent communication and regulatory compliance are essential.

Formación

• Minimum 18 months of medical claim processing experience.
• Experience in high-volume, production-driven environments.
• Ability to manage multiple assignments with accuracy and efficiency.

Responsabilidades

• Review claims and apply guidelines to determine coverage and payments.
• Identify discrepancies and report potential overpayments or underpayments.
• Perform claim rework calculations as needed.
• Provide coaching and mentoring to teammates to improve performance.
• Conduct outbound calls to obtain required information for claims or reconsiderations.

Educación

High School Diploma

Associates degree or equivalent work experience

Descripción del empleo

CVS Health is seeking a full-time Medical Claims Adjudication Specialist in Utah. You will review and adjudicate complex medical claims, coach peers, and support customer service by resolving issues to enhance member experience.

The role requires at least 18 months of medical claim processing experience, strong attention to detail, and the ability to handle multiple priority tasks in a high-volume setting. Excellent communication and regulatory compliance are essential.