Senior Health Claims & Benefits Specialist

CVS Health; Montana; In loco; USD 25.000 - 58.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus/incentive program

Descrizione del lavoro

CVS Health is seeking a full-time Claims Processor in Montana to review and adjudicate self-funded and fully insured claims. You will process refunds, handle customer inquiries, and perform adjustments using claims processing systems, ensuring compliance with medical necessity guidelines and contracts.

The role requires about 2+ years in medical claim processing within a production environment and strong communication and organizational skills.

Competenze

• Approximately 2+ years of medical claims processing experience.
• Experience in a production environment.
• Ability to manage multiple assignments accurately and efficiently.
• Effective communications, organizational, and interpersonal skills.

Mansioni

• Review and adjust self-funded, fully insured, reinsurance, and RX claims per processing guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems as needed.
• Perform adjustments across dollar amounts on claims processing platforms.
• Apply medical necessity guidelines and verify eligibility and coverage details.

Conoscenze

Medical claim processing

Multitasking

Communication skills

Production environment

Formazione

High School Diploma or GED

Descrizione del lavoro

CVS Health is seeking a full-time Claims Processor in Montana to review and adjudicate self-funded and fully insured claims. You will process refunds, handle customer inquiries, and perform adjustments using claims processing systems, ensuring compliance with medical necessity guidelines and contracts.

The role requires about 2+ years in medical claim processing within a production environment and strong communication and organizational skills.