Senior Reinsurance & Stop-Loss Claims Adjuster

CVS Health; Minneota (MN); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a team member to review, research, and adjust complex Reinsurance/Stoploss medical claims. You will split claims into multiple statuses and adjudicate high-dollar cases in accordance with guidelines.

You will collaborate with multiple business functions to ensure accuracy, handle inquiries, and resolve discrepancies while maintaining compliance and quality standards.

Qualifications

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

Responsibilities

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries and concerns.
• Perform Reinsurance/Stoploss claim adjustments across all dollar amounts.
• Follow up on overpayments/underpayments and discrepancies.

Skills

Medical claim processing

Production environment

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a team member to review, research, and adjust complex Reinsurance/Stoploss medical claims. You will split claims into multiple statuses and adjudicate high-dollar cases in accordance with guidelines.

You will collaborate with multiple business functions to ensure accuracy, handle inquiries, and resolve discrepancies while maintaining compliance and quality standards.