Senior Encounter Claims Specialist (Medicaid)

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

Job summary

CVS Health is seeking a Senior Claim Benefit Specialist (Encounter Corrections Analyst) to research, review, and adjudicate complex encounters across Medicaid plans. You will ensure accurate processing in the claims system, drive timely resolution, and support multiple markets in a fast-paced environment.

The role requires medical claims processing experience, strong analytical skills, and proficiency with MS Office.

Qualifications

• 2+ years of medical claims processing experience (Commercial, Medicaid, Medicare).
• Experience working in a production environment.
• Strong analytical and problem-solving skills, especially in researching claims.
• Proficiency in MS Office Suite applications; Excel, Word, OneNote.
• Ability to work independently and as a team.

Responsibilities

• Adjudicate complex, sensitive, and specialized claims with accuracy in the claims processing system.
• Consistently meet quality and production expectations.
• Identify and elevate issues that impact claim payment accuracy or create rework.
• Partner cross-functionally to resolve barriers to encounter acceptance.
• Contributes to the development of desktops and standardized procedures.
• Balance competing priorities while supporting multiple markets.
• Engage in working sessions and meetings that advance business objectives and KPI.

Skills

Medical claims processing

Production environment

Analytical skills

MS Office Suite (Excel, Word, OneNote)

Teamwork

Education

High School Diploma

Job description

CVS Health is seeking a Senior Claim Benefit Specialist (Encounter Corrections Analyst) to research, review, and adjudicate complex encounters across Medicaid plans. You will ensure accurate processing in the claims system, drive timely resolution, and support multiple markets in a fast-paced environment.

The role requires medical claims processing experience, strong analytical skills, and proficiency with MS Office.