Senior Health Claims & Benefits Specialist

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

Job summary

CVS Health is seeking a claims processor to review and adjudicate SF, FI, Reinsurance and RX claims, handling complex cases with attention to guidelines. This full-time role supports provider refunds, returned checks, and customer inquiries.

The position requires 2+ years of medical claim processing experience, the ability to manage multiple tasks, and strong communication and organizational skills, with a typical 40-hour workweek in Minnesota.

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 per guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Perform adjustments across all dollar amount levels on customer service platforms using claims processing expertise.
• Apply medical necessity guidelines and determine coverage; verify eligibility and identify discrepancies.
• Review and interpret medical contract language to determine overpayments and allocate refunds.
• Handle pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and proper payments per company policies.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Education

High School Diploma or GED

Job description

CVS Health is seeking a claims processor to review and adjudicate SF, FI, Reinsurance and RX claims, handling complex cases with attention to guidelines. This full-time role supports provider refunds, returned checks, and customer inquiries.

The position requires 2+ years of medical claim processing experience, the ability to manage multiple tasks, and strong communication and organizational skills, with a typical 40-hour workweek in Minnesota.