Senior Health Claims Adjudication Specialist

CVS Health; Saint Paul (MN); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Minnesota seeks an experienced claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will process refunds and returned checks, resolve customer inquiries, and ensure payments comply with policy and guidelines.

Requires 2+ years of medical claim processing, production environment experience, and strong communication and organizational skills. This full-time, 40-hour weekly role offers comprehensive benefits and bonus eligibility.

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 self-funded, fully insured, reinsurance, and RX claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Apply medical necessity guidelines and determine coverage.
• Follow compliance and ensure accurate payments.
• Assist in claim adjudication and overpayments/underpayments.
• Provide job shadowing to lesser experienced staff.

Skills

Medical claim processing

Production environment

Multitasking

Effective communication

DG system claims processing

Education

High School Diploma or GED

Associate degree preferred

Job description

CVS Health in Minnesota seeks an experienced claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will process refunds and returned checks, resolve customer inquiries, and ensure payments comply with policy and guidelines.

Requires 2+ years of medical claim processing, production environment experience, and strong communication and organizational skills. This full-time, 40-hour weekly role offers comprehensive benefits and bonus eligibility.