Senior Reinsurance & Stop-Loss Claims Adjuster

Internationalinsuranceprofessionals; Boston (MA); On-site; USD 25,000 - 58,000; Full time

Job summary

CVS Health is seeking a Reinsurance/Stoploss Claims Processor to review, adjust and adjudicate complex medical claims in a high-volume setting. You will collaborate with multiple functions, ensure accuracy, handle inquiries, and apply medical necessity guidelines. This full-time role offers a comprehensive benefits package.

Anticipated 40 hours per week; located in Boston, MA. Compensation ranges from $18.50 to $42.35 per hour with bonus eligibility.

Qualifications

• Minimum 2+ years of medical claim processing experience.
• Minimum 2+ years in a production environment.

Responsibilities

• Review, research, and adjust complex Reinsurance/Stoploss medical claims across all dollar amounts.
• Adjudicate high-dollar complex, sensitive, and/or specialized medical claims according to guidelines.
• Handle customer inquiries and concerns.
• Collaborate with key business functions to ensure accuracy in pricing and adjustments.
• Mentor less experienced team members where applicable.

Skills

Medical claim processing

Effective communication

Organizational skills

Interpersonal skills

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a Reinsurance/Stoploss Claims Processor to review, adjust and adjudicate complex medical claims in a high-volume setting. You will collaborate with multiple functions, ensure accuracy, handle inquiries, and apply medical necessity guidelines. This full-time role offers a comprehensive benefits package.

Anticipated 40 hours per week; located in Boston, MA. Compensation ranges from $18.50 to $42.35 per hour with bonus eligibility.