Senior Medical Claims & Benefits Specialist

CVS Health; Baton Rouge (LA); On-site; USD 26,000 - 58,000; Full time

Job summary

CVS Health is hiring a full-time claims processor to support self-funded, fully insured, reinsurance, and RX claims. You will adjudicate complex claims, process refunds, and perform adjustments, applying medical necessity guidelines to ensure accurate coverage and compliant payments.

Required: 2+ years of medical claim processing experience, strong communication, and the ability to manage multiple tasks in a production environment.

Qualifications

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

Responsibilities

• Review and adjudicate SF, FI, Reinsurance, and RX claims.
• Process provider refunds and returned checks.
• Perform claim adjustments and re-work calculations.
• Apply medical necessity guidelines to determine coverage.
• Handle inquiries for pre-approvals and appeals.
• Ensure compliance and proper payments.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Education

High School Diploma or GED

Associate degree

Tools

DG system

Job description

CVS Health is hiring a full-time claims processor to support self-funded, fully insured, reinsurance, and RX claims. You will adjudicate complex claims, process refunds, and perform adjustments, applying medical necessity guidelines to ensure accurate coverage and compliant payments.

Required: 2+ years of medical claim processing experience, strong communication, and the ability to manage multiple tasks in a production environment.