Claim Benefit Specialist

Job not on LinkedIn

🔥 25 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

💻 IT Support

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Review claim documentation and verify policy coverage • Assess claim validity, medical necessity, coding compliance, and documentation requirements • Communicate with healthcare providers and policyholders • Handle and process healthcare provider-submitted claims accurately and efficiently • Determine benefit eligibility and coverage based on insurance plans and policy guidelines • Document claim information, codes, modifiers, and data elements in the company system • Conduct claim reviews and investigations requiring additional scrutiny or validation • Ensure claims processing complies with regulatory requirements, industry standards, and company policies • Meet production, quality, and turnaround-time performance metrics

🎯 Requirements

• 1 year of experience in claims, call center, or related customer service experience in Healthcare • Proficient in computer operations and software applications • Experience in a production environment • Ability to meet production, quality, and turnaround-time performance metrics • Strong teamwork and organizational skills • High School diploma or equivalent GED • Ability to attend the 21-week training period • Applicants must reside in the Central, Mountain, or Pacific Standard Time Zone

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility