Senior Health Claims & Benefits Specialist

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Benefits for colleagues and families

Job summary

CVS Health in Minnesota is seeking an experienced claims processor to review and adjudicate SF, FI, Reinsurance and RX claims, and to handle refunds and inquiries. You will apply medical necessity guidelines, verify eligibility, and ensure compliant payments.

The role requires 2+ years of claim processing experience in a production setting, with strong communication and organizational skills, and a high school diploma or GED. This is a full-time position with comprehensive benefits.

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.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Perform adjustments across all dollar levels on claims platforms using processing expertise.
• Apply medical necessity guidelines to determine coverage and verify eligibility.
• Review contract language to confirm overpayments and allocate refunds.
• Address pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and accurate payments in line with company procedures.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Education

High School Diploma or GED

Associate degree

Job description

CVS Health in Minnesota is seeking an experienced claims processor to review and adjudicate SF, FI, Reinsurance and RX claims, and to handle refunds and inquiries. You will apply medical necessity guidelines, verify eligibility, and ensure compliant payments.

The role requires 2+ years of claim processing experience in a production setting, with strong communication and organizational skills, and a high school diploma or GED. This is a full-time position with comprehensive benefits.