Senior Health Claims Adjudication Specialist

CVS Health; Charlotte (NC); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Job summary

CVS Health in Charlotte, NC is seeking a Claims Processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will verify eligibility, apply medical necessity guidelines, and resolve overpayments and underpayments while supporting customer service inquiries.

Ideal candidates have 2+ years of medical claim processing experience in a production environment, strong communication skills, and the ability to juggle multiple tasks accurately and efficiently.

Qualifications

• 2+ years of medical claim processing experience in a production setting.
• Strong written and verbal communication skills.
• Ability to manage multiple tasks accurately and efficiently.

Responsibilities

• Review and adjudicate self-funded, fully insured, reinsurance, and RX claims.
• Process provider refunds and returned checks and handle inquiries.
• Verify eligibility and apply medical necessity guidelines.
• Identify discrepancies and manage overpayments/underpayments.
• Ensure compliance with company procedures and guidelines.

Skills

Medical claim processing

Production environment experience

Multitasking / prioritization

Communication skills

Education

Associate degree preferred

Job description

CVS Health in Charlotte, NC is seeking a Claims Processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will verify eligibility, apply medical necessity guidelines, and resolve overpayments and underpayments while supporting customer service inquiries.

Ideal candidates have 2+ years of medical claim processing experience in a production environment, strong communication skills, and the ability to juggle multiple tasks accurately and efficiently.