Senior Claims & Integrated Services Specialist

CVS Health; Phoenix (AZ); On-site; USD 25,000 - 49,000; Full time

Job summary

CVS Health is seeking a Senior Integrated Service Specialist in Phoenix to serve as the primary contact for claims-related inquiries and assist with submissions, status updates, denials, and reimbursement issues.

You will also facilitate referrals to in-network providers and contribute to service improvement initiatives, working with clients and providers via multiple channels to resolve needs and optimize enrollment and accounts receivable processes.

Qualifications

• 3 years of customer service experience required.
• 2-3 years of claims processing experience.
• 2-3 years of client support experience.
• Proficiency in Microsoft Word and Excel is required; analytical experience with the ability to interpret data and make informed decisions is essential.

Responsibilities

• Executes routine and non-routine business support tasks for the Integrated Services area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Interfaces with clients and providers via telephone, fax, electronic mail to identify and resolve member needs through analysis and evaluation of information and solutions.
• Researches and updates information using internal systems and resources to resolve enrollment and accounts receivable questions and to process claims and adjustments.
• Manages work distribution including client inquiries via work queues, monitoring, and adjusting workflow accordingly for load balance purposes.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Customer service

Claims processing

Client support

Data analysis

Education

High school diploma or GED

Tools

Microsoft Word

Microsoft Excel

Job description

CVS Health is seeking a Senior Integrated Service Specialist in Phoenix to serve as the primary contact for claims-related inquiries and assist with submissions, status updates, denials, and reimbursement issues.

You will also facilitate referrals to in-network providers and contribute to service improvement initiatives, working with clients and providers via multiple channels to resolve needs and optimize enrollment and accounts receivable processes.