Senior Complex Claims & Benefits Specialist

CVS Health; Bristol (RI); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Paid time off

Job summary

CVS Health is seeking a full-time claims processor in Rhode Island to review and adjudicate a variety of medical claims with a focus on accuracy and efficiency. The role involves processing refunds, handling customer inquiries, and applying medical necessity guidelines to determine coverage while ensuring compliant payments.

The position offers a comprehensive benefits package, eligibility for a bonus program, and a pay range that reflects geography and experience.

Qualifications

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Ability to manage multiple assignments accurately and efficiently.
• Strong communication, organizational and interpersonal skills.
• Associate degree preferred.
• High School Diploma or GED required.

Responsibilities

• Review and adjust self-funded, fully insured, and RX claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries as needed.
• Apply medical necessity guidelines and verify eligibility.
• Ensure compliance and proper payments.
• Review correspondences for claim adjustments.

Skills

Medical claim processing

Production experience

Multitasking

Communication skills

Education

High school diploma or GED

Associate degree preferred

Job description

CVS Health is seeking a full-time claims processor in Rhode Island to review and adjudicate a variety of medical claims with a focus on accuracy and efficiency. The role involves processing refunds, handling customer inquiries, and applying medical necessity guidelines to determine coverage while ensuring compliant payments.

The position offers a comprehensive benefits package, eligibility for a bonus program, and a pay range that reflects geography and experience.