Senior Health Claims & Benefit Specialist

CVS Health; Texas; On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Comprehensive benefits package

Paid time off

Retirement savings options

Job summary

CVS Health in the United States is hiring for a claims processor to review and adjudicate SF, FI, Reinsurance, and RX claims. The role handles adjustments, eligibility checks, and complex provider refunds in a fast-paced production environment.

You will respond to inquiries, ensure compliance, and contribute to a comprehensive benefits package. Candidates typically have 2+ years of medical claim processing experience, strong communication, and an eye for detail.

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 SF (self-funded), FI (fully insured), Reinsurance, and RX claims in accordance with processing guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries related to claims and approvals.
• Ensure compliance and proper payments following company policies.
• Review relevant correspondences and support junior staff as needed.

Skills

Medical claim processing

Production environment

Multitasking

Communication/organization

Education

High School Diploma or GED

Job description

CVS Health in the United States is hiring for a claims processor to review and adjudicate SF, FI, Reinsurance, and RX claims. The role handles adjustments, eligibility checks, and complex provider refunds in a fast-paced production environment.

You will respond to inquiries, ensure compliance, and contribute to a comprehensive benefits package. Candidates typically have 2+ years of medical claim processing experience, strong communication, and an eye for detail.