Claim Benefit Specialist

Job not on LinkedIn

🔥 0 minutes ago

🌐 United States, Ireland – Remote

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🏈 Alabama, Alaska, +43 more states – Remote

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💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Logo of CVS Health

CVS Health

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

• Handle and process benefits claims submitted by healthcare providers • Determine eligibility and coverage of benefits based on insurance plans and policy guidelines • Assess claims for accuracy, coding compliance, medical necessity, and documentation requirements • Document claim information, codes, modifiers, and data elements in the company system • Conduct reviews and investigations requiring additional scrutiny or validation • Communicate with healthcare providers, patients, and other stakeholders to resolve discrepancies • Ensure claims processing complies with regulatory requirements, industry standards, and company policies • Develop and implement regular feedback and formal performance review processes • Analyze claims data and generate reports to identify trends and improvement opportunities

🎯 Requirements

• 1-2 years’ experience working in Healthcare • Strong teamwork and organizational skills • Strong and effective communication skills • Ability to handle multiple assignments through time management, accurately and efficiently • Strong proficiency using computers • Experience with data entry • High School or GED equivalent • Experience in a production environment preferred • Healthcare experience preferred • Knowledge of utilizing multiple systems at once to resolve complex issues preferred • Claim processing experience preferred but not required • Understanding of medical terminology preferred

🏖️ 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

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