Senior Reinsurance & Stoploss Claims Specialist

CVS Health; Phoenix (AZ); Presencial; USD 25.000 - 58.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Descripción de la vacante

CVS Health in Phoenix, AZ seeks a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, collaborating with teams to ensure accurate processing and timely resolutions.

The role requires 2+ years of medical claim processing and experience in a production environment; offers full-time, 40 hours weekly, a competitive pay range of $18.50–$42.35 per hour, and comprehensive benefits.

Formación

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

Responsabilidades

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Split claims into multiple claim statuses.
• Adjudicate high-dollar complex claims per guidelines.
• Collaborate with key business functions for accuracy.
• Handle inquiries and concerns from customers.
• Perform adjustments across all dollar amounts on claims platforms.
• Apply medical necessity guidelines and determine coverage.
• Verify eligibility and identify discrepancies.
• Follow up on overpayments/underpayments and irregularities.
• Interpret complex plan language to ensure accurate adjustments.
• Provide training or mentorship for less experienced staff.

Conocimientos

Medical claim processing

Production environment experience

Educación

Associate degree or equivalent experience

Descripción del empleo

CVS Health in Phoenix, AZ seeks a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, collaborating with teams to ensure accurate processing and timely resolutions.

The role requires 2+ years of medical claim processing and experience in a production environment; offers full-time, 40 hours weekly, a competitive pay range of $18.50–$42.35 per hour, and comprehensive benefits.