Senior Claims & Benefits Strategist

4062 Aetna Resources, LLC; Minnesota; Hybrid; USD 34,000 - 58,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Other resources

Job summary

CVS Health is seeking a dedicated Claims Processor to review and adjudicate self-funded, fully insured, and RX claims in Minnesota. You will apply medical necessity guidelines, verify eligibility, and resolve overpayments or underpayments while handling refunds and inquiries.

In a production environment, you’ll manage multiple claims with accuracy and strong communication, following company policies to ensure compliant payments and timely resolutions for providers and members.

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.
• Handle customer service inquiries and problems.
• Perform adjustments across all dollar amounts on claims platforms.
• Apply medical necessity guidelines and determine coverage.
• Process overpayments, underpayments and other irregularities.

Skills

Medical claim processing

Production environment

Communication skills

Multi-tasking

Education

High School Diploma or GED

Associate degree preferred

Job description

CVS Health is seeking a dedicated Claims Processor to review and adjudicate self-funded, fully insured, and RX claims in Minnesota. You will apply medical necessity guidelines, verify eligibility, and resolve overpayments or underpayments while handling refunds and inquiries.

In a production environment, you’ll manage multiple claims with accuracy and strong communication, following company policies to ensure compliant payments and timely resolutions for providers and members.