Senior Health Claims & Benefits Specialist

CVS Health; Topeka (KS); On-site; USD 25,000 - 58,000; Full time

Job summary

CVS Health seeks a dedicated claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will handle provider refunds, refunds checks, and complex inquiries while ensuring compliance with guidelines and company policies.

The role requires 2+ years of medical claim processing experience, strong organizational and communication skills, and the ability to manage multiple tasks in a production environment. 40-hour weeks with competitive 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, FI, Reinsurance, and RX claims; adjudicates complex claims.
• Process provider refunds and returned checks.
• Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure all compliance requirements are satisfied and that payments follow company practices.

Skills

Medical claim processing

Production experience

Multitasking

Communication skills

Education

High School Diploma or GED

Associate degree preferred

Tools

DG system claims processing

Job description

CVS Health seeks a dedicated claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims. You will handle provider refunds, refunds checks, and complex inquiries while ensuring compliance with guidelines and company policies.

The role requires 2+ years of medical claim processing experience, strong organizational and communication skills, and the ability to manage multiple tasks in a production environment. 40-hour weeks with competitive benefits.