Senior Reinsurance & Stoploss Claims Specialist

CVS Health; Florida; Híbrido; USD 25.000 - 58.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Welfare programs

Other resources

Descripción de la vacante

CVS Health is recruiting for a Reinsurance/Stoploss Claims Adjudicator in Florida. This role reviews complex medical claims, applies medical necessity guidelines, and collaborates with teams to ensure accurate adjustments.

You will handle inquiries and perform high-value claim adjustments across all dollar levels. Ideal candidates have at least 2+ years of medical claim processing experience and an associate degree or equivalent.

Formación

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

Responsabilidades

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Adjudicates high-dollar complex, sensitive claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries and concerns.
• Perform adjustments across all dollar amounts using claims processing expertise.

Conocimientos

Medical claim processing

Production environment

Educación

Associate degree or equivalent experience

Descripción del empleo

CVS Health is recruiting for a Reinsurance/Stoploss Claims Adjudicator in Florida. This role reviews complex medical claims, applies medical necessity guidelines, and collaborates with teams to ensure accurate adjustments.

You will handle inquiries and perform high-value claim adjustments across all dollar levels. Ideal candidates have at least 2+ years of medical claim processing experience and an associate degree or equivalent.