Claims Benefit Specialist

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🔥 16 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💻 IT Support

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Attendance during the 21 week training period is required. • Reviews and adjudicates claims in accordance with claim processing guidelines. • Enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. • Determine and understand the coverage provided under a member's health plan. • Efficiently use multiple systems and screens to obtain and record claim information. • Review claims information to determine the nature of a member's illness or injury. • Identify claim cost management opportunities and refer claims for follow up. • Make claim payment decisions. • Process claims accurately to enhance customer satisfaction and retention. • Process claims within quality and production standards. • Assist team members in support of achieving team, office, regional, and national goals.

🎯 Requirements

• Experience in a quality and production environment. • Attention to detail. • Ability to use multiple computer applications at one time. • Claim processing experience. • Exceptional analytical skills. • Accurate and fast keyboarding skills. • Advanced computer navigation and knowledge in a Windows environment. • Effective verbal and written communication skills. • Positive, willing attitude. • Prior medical claim processing experience is a plus.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility