Senior Medical Claims & Benefits Specialist

CVS Health; Montgomery (AL); On-site; USD 26,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a detail-oriented claims processor in Montgomery, AL. The role reviews and adjudicates self-funded, fully insured, and RX claims, ensuring accurate payments and compliance.

You will handle refunds, returned checks, and complex inquiries, applying medical necessity guidelines and cost containment measures. The ideal candidate has 2+ years of medical claim processing experience, thrives in a production setting, and demonstrates strong communication and organizational skills.

Qualifications

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

Responsibilities

• Review and adjudicate SF, FI, Reinsurance, and RX claims per guidelines.
• Process provider refunds and returned checks; perform claim re-work as needed.
• Ensure compliance and accurate payments; handle inquiries and appeals.
• Provide guidance and potential job shadowing for less experienced staff.

Skills

Medical claim processing

Production environment

Multitasking

Communication skills

Education

High School Diploma or GED

Job description

CVS Health is seeking a detail-oriented claims processor in Montgomery, AL. The role reviews and adjudicates self-funded, fully insured, and RX claims, ensuring accurate payments and compliance.

You will handle refunds, returned checks, and complex inquiries, applying medical necessity guidelines and cost containment measures. The ideal candidate has 2+ years of medical claim processing experience, thrives in a production setting, and demonstrates strong communication and organizational skills.