Senior Reinsurance & Stoploss Claims Specialist

Internationalinsuranceprofessionals; Lansing (MI); Vor Ort; USD 25.000 - 58.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Wellness programs

Zusammenfassung

CVS Health is seeking a full-time Reinsurance/Stoploss Claims Adjuster to analyze and adjust complex medical claims, ensuring accuracy and compliance. You will collaborate with multiple teams, apply medical necessity guidelines, and resolve inquiries efficiently.

The role requires attention to detail, strong communication, and the ability to handle high-dollar adjustments. A supportive benefits package accompanies the position.

Qualifikationen

• Minimum 2+ years in medical claim processing.
• Experience in a production environment is required.
• Ability to review complex claims and apply guidelines.
• Strong communication and organizational skills.

Aufgaben

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with business functions to ensure accuracy in claim adjustments.
• Handle customer inquiries and concerns related to claims.
• Apply medical necessity guidelines and verify eligibility.
• Perform re-work calculations and reconcile discrepancies.
• Mentor less experienced team members when needed.

Kenntnisse

Medical claim processing

Production environment experience

Ausbildung

Associate degree

Jobbeschreibung

CVS Health is seeking a full-time Reinsurance/Stoploss Claims Adjuster to analyze and adjust complex medical claims, ensuring accuracy and compliance. You will collaborate with multiple teams, apply medical necessity guidelines, and resolve inquiries efficiently.

The role requires attention to detail, strong communication, and the ability to handle high-dollar adjustments. A supportive benefits package accompanies the position.