Senior Health Claims & Benefit Specialist

CVS Health; New Jersey; Presencial; USD 25 000 - 58 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive benefits package

Bonus eligibility

Short-term incentive program

Resumo da oferta

CVS Health in New Jersey seeks a claims processor to adjudicate medical claims, including self-funded and fully insured plans, with emphasis on accuracy and compliance. The role involves processing refunds, handling inquiries, and applying medical necessity guidelines to determine coverage.

You will support the claims team in resolving complex issues in a full-time, benefits-focused environment. Eligible candidates will have 2+ years of claim processing experience, strong communication skills,

Qualificações

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Ability to manage multiple assignments accurately.
• Strong communications and interpersonal skills.

Responsabilidades

• Review and adjust SF, FI, Reinsurance, and RX claims in accordance with guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Apply medical necessity guidelines and determine coverage; verify eligibility.
• Perform claim re-work and correct overpayments/underpayments; respond to related correspondences.
• Ensure compliance and timely payments following company practices and procedures.
• May provide job shadowing to less experienced staff.

Conhecimentos

Claim processing

Production environment

Multitasking

Communication skills

Formação académica

High School Diploma or GED

Associate degree preferred

Descrição da oferta de emprego

CVS Health in New Jersey seeks a claims processor to adjudicate medical claims, including self-funded and fully insured plans, with emphasis on accuracy and compliance. The role involves processing refunds, handling inquiries, and applying medical necessity guidelines to determine coverage.

You will support the claims team in resolving complex issues in a full-time, benefits-focused environment. Eligible candidates will have 2+ years of claim processing experience, strong communication skills,