Senior Health Claims & Benefits Specialist

CVS Health; Olympia (WA); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health in Olympia, WA is seeking a Full-time Medical Claims Processor to review and adjudicate self-funded and fully insured claims. You will process refunds, verify eligibility, and apply cost containment measures while handling customer inquiries with accuracy and care.

The role requires 2+ years in medical claim processing, strong organizational skills, and effective communication. Anticipated weekly hours are 40, with a comprehensive benefits package and eligibility for bonuses.

Qualifications

• 2+ years in medical claim processing or similar environment.
• Experience in a production/claims processing setting.
• Ability to handle multiple tasks accurately and efficiently.
• Strong communication and organizational skills.

Responsibilities

• Review and adjust various claim types (SF, FI, Reinsurance, RX) and process provider refunds.
• Apply medical necessity guidelines and determine coverage and eligibility.
• Handle complex claim re-work, over/underpayments, and related discrepancies.
• Respond to inquiries about pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and proper payment procedures while managing related correspondences.

Skills

Medical claim processing

Customer service

Detail oriented

Communication skills

Education

High School Diploma or GED

Job description

CVS Health in Olympia, WA is seeking a Full-time Medical Claims Processor to review and adjudicate self-funded and fully insured claims. You will process refunds, verify eligibility, and apply cost containment measures while handling customer inquiries with accuracy and care.

The role requires 2+ years in medical claim processing, strong organizational skills, and effective communication. Anticipated weekly hours are 40, with a comprehensive benefits package and eligibility for bonuses.