Senior Health Claims & Benefits Specialist

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

Job summary

CVS Health is seeking a claims processor to review and adjudicate medical claims across self-funded and fully insured programs. You will process refunds, handle inquiries, and ensure payments comply with guidelines, working in a production environment with a strong emphasis on accuracy.

The role requires at least 2 years of medical claim processing experience and a High School Diploma or GED. Associate degree is preferred, with a typical 40-hour work week and eligibility for bonuses based on

Qualifications

• 2+ years medical claim processing experience.
• Experience in a production environment.
• Ability to manage multiple assignments.
• Effective communication and interpersonal skills.
• High School Diploma or GED.

Responsibilities

• Review and adjust self-funded, fully insured, and RX claims per guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries and issues.
• Perform claim adjustments and re-work calculations.
• Ensure compliance and correct payments per procedures.
• Interpret medical contract language to determine over/underpayments.
• Support team with job shadowing and guidance.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Organizational skills

Interpersonal skills

Education

High School Diploma or GED

Associate degree preferred

Job description

CVS Health is seeking a claims processor to review and adjudicate medical claims across self-funded and fully insured programs. You will process refunds, handle inquiries, and ensure payments comply with guidelines, working in a production environment with a strong emphasis on accuracy.

The role requires at least 2 years of medical claim processing experience and a High School Diploma or GED. Associate degree is preferred, with a typical 40-hour work week and eligibility for bonuses based on