Senior Claim Data Specialist, Provider Claims

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🔥 11 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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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

• Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries • Determine whether any claim payment or denial issues are present • Submit the necessary documents to specific areas to ensure all is updated and corrected • Submit all projects and/or claims to be reprocessed • Perform education for providers, both internal and external, when required • Attend provider group meetings, as well as individual meetings, both internally and externally • Submit projects within Microsoft Excel as assigned • Perform other duties as needed

🎯 Requirements

• 1-3 years of medical claims experience • 1-3 years of intermediate Excel experience with demonstrated proficiency in formulas, pivot tables and vlookups • Must reside in Florida • Bilingual in English/Spanish (preferred) • 2+ years of provider claims experience (preferred) • Certified Professional Coder (CPC) (preferred) • Knowledge of provider billing, particularly with professional and hospital claims (preferred) • Strong attention to detail • Excellent communication, collaboration, and relationship building skills • Self-motivated and ability to drive independent work • Strong writing and documentation skills

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs