Strategic Reinsurance & Stoploss Claims Adjudicator

CVS Health; Lansing (MI); On-site; USD 25,000 - 58,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health in Michigan seeks a Reinsurance/Stoploss Claims Adjuster to review and adjust complex medical claims, and to collaborate across departments for accurate pricing and payments. The role involves handling inquiries, ensuring compliance, and may include training responsibilities.

The position offers full-time hours, a comprehensive benefits package, and opportunities to contribute to a high-volume claims team focused on accuracy and efficiency.

Qualifications

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

Responsibilities

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with business functions to ensure accuracy in adjustments.
• Handle inquiries related to pre-approvals, reconsiderations, or appeals.
• Manage external correspondence and adjustments to medical claims.
• Deliver training or mentorship for less experienced team members.

Skills

Medical claim processing

Production environment

Education

Associate degree or equivalent experience

Job description

CVS Health in Michigan seeks a Reinsurance/Stoploss Claims Adjuster to review and adjust complex medical claims, and to collaborate across departments for accurate pricing and payments. The role involves handling inquiries, ensuring compliance, and may include training responsibilities.

The position offers full-time hours, a comprehensive benefits package, and opportunities to contribute to a high-volume claims team focused on accuracy and efficiency.