Senior Claims & Benefits Specialist – Health Coverage

CVS Health; Provo (UT); 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

Job summary

CVS Health is seeking a claims processor to review and adjust self-funded, fully insured, reinsurance, and RX claims. The role includes handling refunds, customer inquiries, and complex adjustments with strict adherence to guidelines.

Qualifications include 2+ years in medical claim processing and the ability to manage multiple tasks in a production setting. Strong communication, organization, and interpersonal skills are required.

Qualifications

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Effective communications, organizational, and interpersonal skills.

Responsibilities

• Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Perform adjustments across all dollar amounts on claims processing platforms.
• Apply medical necessity guidelines and determine coverage.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Education

High School Diploma or GED

Associate degree preferred

Job description

CVS Health is seeking a claims processor to review and adjust self-funded, fully insured, reinsurance, and RX claims. The role includes handling refunds, customer inquiries, and complex adjustments with strict adherence to guidelines.

Qualifications include 2+ years in medical claim processing and the ability to manage multiple tasks in a production setting. Strong communication, organization, and interpersonal skills are required.