Senior Reinsurance & Stoploss Claims Specialist

CVS Health; Helena (MT); In loco; USD 25.000 - 58.000; Tempo pieno

Descrizione del lavoro

CVS Health is seeking an experienced Reinsurance/Stoploss Claims Adjuster to review and adjust complex medical claims. You will collaborate with multiple teams to ensure accurate pricing, payments, and compliance.

The role involves researching plan language, handling high-dollar adjustments, and communicating with customers about pre-authorizations and appeals. Ideal candidates have 2+ years in medical claim processing, experience in a production setting, and an Associate degree or equivalent.

Competenze

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

Mansioni

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key business functions to ensure accuracy in claim adjustments and resolve discrepancies.
• Handle customer inquiries and concerns related to claims adjustments.
• Perform claim adjustments across all dollar levels on customer service platforms using technical and processing expertise.
• Follow through on overpayments, underpayments, and other irregularities in Reinsurance/Stoploss claims.

Conoscenze

Medical claim processing

Production environment experience

Formazione

Associate degree or equivalent experience

Descrizione del lavoro

CVS Health is seeking an experienced Reinsurance/Stoploss Claims Adjuster to review and adjust complex medical claims. You will collaborate with multiple teams to ensure accurate pricing, payments, and compliance.

The role involves researching plan language, handling high-dollar adjustments, and communicating with customers about pre-authorizations and appeals. Ideal candidates have 2+ years in medical claim processing, experience in a production setting, and an Associate degree or equivalent.