Strategic Reinsurance & Stoploss Claims Adjuster

CVS Health; Jackson (MS); Sur place; USD 26 000 - 58 000; Plein temps

Avantages offerts par ce poste

Bonus program

Benefits package

Résumé du poste

CVS Health is seeking a Detail-Oriented Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims in a fast-paced environment. You will work across departments to ensure accurate adjustments, apply medical necessity guidelines, and assist clients with inquiries.

The role emphasizes accuracy, compliance, and effective communication to support our health care customers. The position requires 2+ years in medical claim processing and a background in a production

Qualifications

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

Responsabilités

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Apply medical necessity guidelines to determine coverage and verify eligibility.
• Perform re-work calculations and interpret plan language for accurate adjustments.
• Handle inquiries regarding pre-approvals/pre-authorizations, reconsiderations, or appeals.
• Ensure compliance and manage external correspondence for adjustments.

Connaissances

Medical claim processing

Production environment

Formation

Associate degree or equivalent experience

Description du poste

CVS Health is seeking a Detail-Oriented Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims in a fast-paced environment. You will work across departments to ensure accurate adjustments, apply medical necessity guidelines, and assist clients with inquiries.

The role emphasizes accuracy, compliance, and effective communication to support our health care customers. The position requires 2+ years in medical claim processing and a background in a production