Senior Health Claims & Benefit Specialist

CVS Health; Hartford (CT); Vor Ort; USD 26.000 - 58.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Zusammenfassung

CVS Health in Hartford, CT is hiring a full-time Claims Processor to review and adjust self-funded, fully insured, reinsurance and RX claims. You will adjudicate complex claims, process refunds, and perform adjustments across all dollar levels using claims processing systems.

The role requires applying medical necessity guidelines and handling inquiries for pre-approvals and appeals. The position offers a comprehensive benefits package and eligibility for CVS Health bonus programs, with a

Qualifikationen

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Ability to handle multiple assignments accurately and efficiently.
• Effective communication, organization, and interpersonal skills.

Aufgaben

• Review and adjust SF, FI, Reinsurance, and RX claims.
• Process provider refunds and returned checks.
• Perform adjustments across dollar levels on claims platforms.
• Apply medical necessity guidelines and determine coverage.
• Handle inquiries for pre-approvals, reconsiderations or appeals.

Kenntnisse

Medical claim processing

Production environment

Multitasking

Communication skills

Ausbildung

High School Diploma or GED

Associate degree preferred

Jobbeschreibung

CVS Health in Hartford, CT is hiring a full-time Claims Processor to review and adjust self-funded, fully insured, reinsurance and RX claims. You will adjudicate complex claims, process refunds, and perform adjustments across all dollar levels using claims processing systems.

The role requires applying medical necessity guidelines and handling inquiries for pre-approvals and appeals. The position offers a comprehensive benefits package and eligibility for CVS Health bonus programs, with a