Senior Medical Claims Adjudication Specialist

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

Benefits offered by this job

Benefits package

Job summary

CVS Health in Vermont is seeking a claims processor to review and adjudicate self-funded and fully insured medical claims, process refunds, and handle inquiries. This full-time role requires ~2+ years of experience and a strong ability to manage multiple tasks with accuracy and efficiency.

The position emphasizes effective communication, organizational skills, and adherence to guidelines, with comprehensive benefits and a competitive pay range.

Qualifications

• 2+ years medical claim processing experience.
• Experience in a production environment.
• Ability to handle multiple assignments competently, accurately, and efficiently.
• Effective communication, organizational, and interpersonal skills.

Responsibilities

• Review and adjudicate claims across SF, FI, Reinsurance, and RX.
• Process provider refunds and returned checks.
• Handle customer service inquiries as needed.
• Apply medical necessity guidelines and verify eligibility.
• Identify discrepancies and apply cost containment measures.
• Follow up on claim overpayments/underpayments.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Organizational skills

Education

High School Diploma or GED

Job description

CVS Health in Vermont is seeking a claims processor to review and adjudicate self-funded and fully insured medical claims, process refunds, and handle inquiries. This full-time role requires ~2+ years of experience and a strong ability to manage multiple tasks with accuracy and efficiency.

The position emphasizes effective communication, organizational skills, and adherence to guidelines, with comprehensive benefits and a competitive pay range.