Senior Claim Benefit Specialist – Checkwork/Refund

Job not on LinkedIn

🔥 14 hours ago

❄️ Minnesota – Remote

❄️ Minnesota – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Process complex, non-routine provider refunds and returned checks • Review and interpret contract language to validate overpayments and allocate refund checks appropriately • Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and implement cost-containment measures • Ensure compliance requirements are met and payments and refunds follow company policies and procedures • Perform claim rework calculations and adjustments for unsolicited overpayment refunds • Resolve medical claim overpayments, underpayments, and other irregularities • Respond to telephone and written inquiries related to preapprovals, prior authorizations, reconsiderations, and appeals • Review assigned claims data-mining work and complete resulting adjustments • Process medical claim adjustments on customer service platforms • Provide overpayment refund training, mentoring, and job-shadowing support to less experienced colleagues • Use available resource materials and tools to manage responsibilities • Handle assigned customer service inquiries and issues • Partner with key business functions to ensure accurate posting of overpayment refunds, reconcile discrepancies, and respond to internal and provider inquiries

🎯 Requirements

• 3+ years of medical claims processing experience • 2+ years of hands-on claim adjustment and rework experience • 2+ years of experience in a production environment with volume and accuracy standards • Demonstrated experience researching and resolving claim issues from initiation through resolution • Ability to interpret and apply guidelines related to eligibility, coverage, and benefits • Strong attention to detail • High school diploma or equivalent required • Experience reviewing and researching overpayment refunds • DG system claims processing experience • Ability to manage multiple assignments accurately and efficiently • Effective communication, organizational, and interpersonal skills • Familiarity with overpayment recovery processes

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility

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