Senior Medical Claims & Benefits Specialist

CVS Health; Philadelphia (Philadelphia County); Sur place; USD 25 000 - 58 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Résumé du poste

CVS Health in Philadelphia is seeking a claims processor to review and adjust self-funded, fully insured, reinsurance and RX claims. You will process refunds, handle inquiries, and perform adjustments across dollar amounts with claims-processing expertise.

You will apply medical necessity guidelines, verify eligibility, and manage overpayments, underpayments, and other irregularities while ensuring compliance and accurate payments. This full-time role offers benefits and bonus eligibility.

Qualifications

• 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.

Responsabilités

• Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and RX claims.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems; perform adjustments using claims processing expertise.
• Apply medical necessity guidelines and determine coverage; verify eligibility.

Connaissances

Medical claim processing

Production environment

Multi-tasking

Communication skills

Formation

High School Diploma or GED

Outils

DG system

Description du poste

CVS Health in Philadelphia is seeking a claims processor to review and adjust self-funded, fully insured, reinsurance and RX claims. You will process refunds, handle inquiries, and perform adjustments across dollar amounts with claims-processing expertise.

You will apply medical necessity guidelines, verify eligibility, and manage overpayments, underpayments, and other irregularities while ensuring compliance and accurate payments. This full-time role offers benefits and bonus eligibility.