Senior Health Claims Adjudication Specialist

CVS Health; West Virginia; Presencial; USD 25 000 - 58 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Benefits package

Bonus eligibility

Resumo da oferta

CVS Health is seeking a full‑time Claims Processor in the United States (West Virginia) to review and adjudicate complex medical claims, including self-funded and fully insured plans. The role includes processing refunds, handling provider inquiries, and ensuring compliance with contract language.

The position requires 2+ years of medical claim processing experience in a production environment, with strong multitasking and communication skills.

Qualificações

• 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.

Responsabilidades

• Review and adjust SF, FI, Reinsurance, and RX claims per guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Perform adjustments across dollar amounts on claims processing platforms.
• Identify discrepancies and apply cost containment measures in adjudication.

Conhecimentos

Medical claim processing

Production environment experience

Multitasking

Communication skills

Formação académica

High School Diploma or GED

Ferramentas

DG system claims processing

Descrição da oferta de emprego

CVS Health is seeking a full‑time Claims Processor in the United States (West Virginia) to review and adjudicate complex medical claims, including self-funded and fully insured plans. The role includes processing refunds, handling provider inquiries, and ensuring compliance with contract language.

The position requires 2+ years of medical claim processing experience in a production environment, with strong multitasking and communication skills.