Senior Medical Claims Specialist – Complex Adjudication

CVS Health; Lansing (MI); On-site; USD 25,000 - 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 hiring for a full-time role focused on reviewing and adjusting medical claims across self-funded, fully insured, reinsurance, and RX lines. You will apply medical necessity guidelines, verify eligibility, and manage complex claim adjudication while handling refunds and inquiries.

The position requires 2+ years in medical claim processing in a production environment, with strong organization and communication skills. 40-hour weeks, base pay with a comprehensive benefits package.

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.

Responsibilities

• Review and adjust SF/FI/Reinsurance/RX claims according to guidelines.
• Process provider refunds and returned checks.
• Handle customer service inquiries and problems related to claims.

Skills

Medical claim processing

Production environment

Multi-tasking

Communication skills

Education

High School diploma or GED

Job description

CVS Health is hiring for a full-time role focused on reviewing and adjusting medical claims across self-funded, fully insured, reinsurance, and RX lines. You will apply medical necessity guidelines, verify eligibility, and manage complex claim adjudication while handling refunds and inquiries.

The position requires 2+ years in medical claim processing in a production environment, with strong organization and communication skills. 40-hour weeks, base pay with a comprehensive benefits package.