Senior Medical Claims & Benefits Operations Specialist

4004 Aetna Medicaid Administrators; Arizona; Hybrid; USD 25,000 - 49,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health in the United States is seeking an experienced medical claims processor to adjudicate complex encounters and support multiple Medicaid plans. The role requires strong analytical skills and the ability to work in a fast-paced production environment.

The position demands proficiency with MS Office, independent work capabilities, and teamwork. It offers a full-time schedule (40 hours) with a comprehensive benefits package and opportunities for cross‑functional collaboration across

Qualifications

• Minimum 2 years of medical claims processing experience (Commercial, Medicaid, Medicare).
• Experience working in a production environment.
• Strong analytical and problem‑solving skills, especially in researching claims.
• Proficiency in MS Office Suite applications; Excel, Word, OneNote.
• Ability to work independently and as a team.

Responsibilities

• Researches, reviews, and adjudicates complex, sensitive, and specialized encounters in accordance with state‑specific processing guidelines.
• Adjudicate complex, sensitive, and specialized claims with accuracy in the claims processing system.
• Drive timely resolution of encounter errors using available resources, tools, and research.
• Balance competing priorities while supporting multiple markets.
• Partner cross‑functionally to resolve barriers to encounter acceptance.
• Contributes to the development of desktops and standardized procedures.

Skills

Claims processing

Analytical

MS Office

Teamwork

Independent work

Education

High School Diploma

Tools

QNXT

Facets

Edifecs

Job description

CVS Health in the United States is seeking an experienced medical claims processor to adjudicate complex encounters and support multiple Medicaid plans. The role requires strong analytical skills and the ability to work in a fast-paced production environment.

The position demands proficiency with MS Office, independent work capabilities, and teamwork. It offers a full-time schedule (40 hours) with a comprehensive benefits package and opportunities for cross‑functional collaboration across