Senior Claims & Benefits Specialist — Health Impact

CVS Health; Bismarck (ND); On-site; USD 25,000 - 58,000; Full time

Job summary

CVS Health is seeking a Claims Specialist to review and adjust self-funded, fully insured, reinsurance, and RX claims, handling complex cases with precision. You will verify eligibility, determine coverage, and apply cost containment measures while processing refunds and customer inquiries.

The role demands accuracy, strong communication, and the ability to manage multiple tasks in a timely manner. Full-time, on-site position with comprehensive benefits.

Qualifications

• 2+ years 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, FI, Reinsurance, and RX claims per guidelines.
• Process provider refunds and returned checks and handle complex inquiries.
• Apply medical necessity guidelines to determine coverage and eligibility.
• Follow through on claim overpayments/underpayments and irregularities.
• Ensure compliance and proper payments; assist with escalations as needed.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Education

High School Diploma or GED

Job description

CVS Health is seeking a Claims Specialist to review and adjust self-funded, fully insured, reinsurance, and RX claims, handling complex cases with precision. You will verify eligibility, determine coverage, and apply cost containment measures while processing refunds and customer inquiries.

The role demands accuracy, strong communication, and the ability to manage multiple tasks in a timely manner. Full-time, on-site position with comprehensive benefits.