Senior Medical Claims & Benefits Specialist

CVS Health; Clifton (TX); Presencial; USD 25 000 - 58 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Wellness program

Paid time off

Bonus potential

Resumo da oferta

CVS Health is seeking a claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims, process refunds, and assist customers with inquiries. The role applies medical necessity guidelines, verifies eligibility, and ensures proper cost containment and payment accuracy.

The position requires 2+ years of medical claim processing experience, a high school diploma, and the ability to manage multiple tasks in a production environment.

Qualificações

• 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.

Responsabilidades

• Review and adjust self-funded, fully insured, Reinsurance, and RX claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems.
• Perform claim adjustments across dollar amounts on processing platforms.
• Ensure compliance and accurate payments.

Conhecimentos

Medical claim processing

Production environment experience

Multitasking ability

Communication skills

Formação académica

High School Diploma or GED

Descrição da oferta de emprego

CVS Health is seeking a claims processor to review and adjudicate self-funded, fully insured, reinsurance, and RX claims, process refunds, and assist customers with inquiries. The role applies medical necessity guidelines, verifies eligibility, and ensures proper cost containment and payment accuracy.

The position requires 2+ years of medical claim processing experience, a high school diploma, and the ability to manage multiple tasks in a production environment.