Claim Benefit Specialist

Job not on LinkedIn

🔥 0 minutes ago

🌵 Arizona, California, +9 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🥔 Idaho – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote 🦬 Wyoming – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Handle and process benefits claims submitted by healthcare providers • Determine benefits eligibility and coverage 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 company systems • Review and investigate claims requiring additional scrutiny • Communicate with healthcare providers, patients, and stakeholders to resolve discrepancies • Ensure claims processing complies with regulatory requirements, industry standards, and company policies • Review and adjudicate routine claims according to processing guidelines • Analyze and approve routine claims that cannot be auto-adjudicated • Apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost-containment measures • Coordinate responses to routine phone inquiries and written correspondence • Route and triage complex claims to Senior Claim Benefits Specialists • Review submissions for coding, member identification, diagnosis, and pre-coding requirements • Manage claims queues and ECHS within turnaround-time requirements • Use applicable system functions and post-containment tools for accurate, timely processing • Analyze claims data and generate reports to identify trends and improvement areas • Provide feedback and support performance review, engagement, motivation, and team development • May facilitate training as a subject matter expert

🎯 Requirements

• Less than 1 year work experience • Working knowledge of problem solving and decision making skills • High school diploma or equivalent required • Experience in a production environment • Claims processing experience in any field • Must live in and work the Arizona, Mountain or Pacific Time Zones • Availability for training Monday through Friday, 6am–2:30pm PST for 20 weeks • Preferred: Medicaid experience • Preferred: QNXT experience • Preferred: Medical Coding knowledge • Preferred: Microsoft Outlook/Excel proficiency

🏖️ Benefits

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