Senior Medical Claims & Benefits Specialist

CVS Health; North Dakota; On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a claims processor in North Dakota to review and adjudicate complex self-funded and fully insured claims. You will process refunds, handle inquiries, and apply medical necessity guidelines to determine coverage and verify eligibility.

The role requires about 2+ years in medical claim processing, strong multitasking and communication skills, and a high school diploma or GED. This is a full-time on-site position with competitive benefits and a base pay range.

Qualifications

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

Responsibilities

• Review and adjust self-funded and fully insured claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries related to claims.
• Apply medical necessity guidelines and verify eligibility.
• Perform claim re-work calculations.
• Address claim overpayments and underpayments.
• Review provider contracts to confirm overpayments.
• Support adherence to compliance and payment procedures.

Skills

Medical claims processing

Multitasking

Communication skills

Education

High School Diploma or GED

Tools

DG system claims processing

Job description

CVS Health is seeking a claims processor in North Dakota to review and adjudicate complex self-funded and fully insured claims. You will process refunds, handle inquiries, and apply medical necessity guidelines to determine coverage and verify eligibility.

The role requires about 2+ years in medical claim processing, strong multitasking and communication skills, and a high school diploma or GED. This is a full-time on-site position with competitive benefits and a base pay range.