Senior Health Claims & Benefits Specialist

CVS Health; Nashville (TN); Presencial; USD 25 000 - 58 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical benefits

Dental & Vision

Paid time off

Retirement savings

Wellness programs

Resumo da oferta

CVS Health in Nashville, TN is seeking a full-time Claims Processor to review and adjudicate complex medical claims across self-funded and fully insured plans. You will also process refunds and returned checks, apply medical necessity guidelines, and ensure compliance with policy and payment procedures.

The role requires 2+ years in medical claim processing, experience in a production environment, and strong communication skills. Eligible for CVS Health bonus program with comprehensive benefits.

Qualificações

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Ability to handle multiple assignments accurately and efficiently; strong organizational skills.

Responsabilidades

• Review and adjudicate complex claims across self-funded and fully insured plans.
• Process provider refunds and returned checks and perform claim re-work.
• Ensure compliance and proper payments following company policies.
• Handle inquiries about pre-approvals, reconsiderations, or appeals.

Conhecimentos

Medical claims processing

Production environment

Multitasking & accuracy

Communication & interpersonal

Formação académica

High School Diploma or GED

Associate degree preferred

Descrição da oferta de emprego

CVS Health in Nashville, TN is seeking a full-time Claims Processor to review and adjudicate complex medical claims across self-funded and fully insured plans. You will also process refunds and returned checks, apply medical necessity guidelines, and ensure compliance with policy and payment procedures.

The role requires 2+ years in medical claim processing, experience in a production environment, and strong communication skills. Eligible for CVS Health bonus program with comprehensive benefits.