Senior Medical Claims & Benefits Analyst

CVS Health; Elm (PA); On-site; USD 26,000 - 58,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Job summary

CVS Health is seeking a full-time Claims Processor in Pennsylvania to review and adjudicate self-funded, fully insured, and RX claims, process refunds, and assist with inquiries. You will apply medical necessity guidelines to determine coverage and manage complex claim scenarios.

In a production environment, you will handle multiple tasks, perform adjustments, and ensure compliant, accurate payments. Competitive hourly pay, bonus eligibility, and benefits are offered.

Qualifications

• 2+ years of medical claim processing experience.

Responsibilities

• Review and adjust SF, FI, Reinsurance, and RX claims.

Skills

Medical claim processing

Production environment experience

Multitasking

Communication skills

Education

High School Diploma or GED

Associate degree preferred

Tools

DG system claims processing

Job description

CVS Health is seeking a full-time Claims Processor in Pennsylvania to review and adjudicate self-funded, fully insured, and RX claims, process refunds, and assist with inquiries. You will apply medical necessity guidelines to determine coverage and manage complex claim scenarios.

In a production environment, you will handle multiple tasks, perform adjustments, and ensure compliant, accurate payments. Competitive hourly pay, bonus eligibility, and benefits are offered.