Senior Claim Benefit Adjuster

Job not on LinkedIn

🔥 1 minute ago

🏈 Alabama, Arizona, +43 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote 🍑 Georgia – Remote

💵 $18 - $42 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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• Just posted.
• Jobs at this company usually fill in 21 days.

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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 and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims • Adjudicate complex, sensitive, and/or specialized claims according to claim processing guidelines • Process provider refunds and returned checks • Handle customer service inquiries and problems • Perform adjustments across all dollar amount levels on customer service platforms using technical and claims processing expertise • Apply medical necessity guidelines and determine coverage • Complete eligibility verification and identify discrepancies • Apply cost containment measures during claim adjudication • Perform claim re-work calculations • Complete claim overpayments, underpayments, and other irregularities • Process complex non-routine provider refunds and returned checks • Review and interpret medical contract language and provider contracts to confirm claim overpayments and allocate refund checks • Handle telephone and written inquiries regarding pre-approvals/pre-authorizations, reconsiderations, or appeals • Ensure compliance requirements are satisfied and payments follow company practices and procedures • Review and handle correspondence that may result in claim adjustments • Provide job shadowing to less-experienced staff as needed • Utilize resource materials to manage job responsibilities

🎯 Requirements

• 2+ years medical claim processing experience • 2+ years experience in a production environment • Demonstrated ability to handle multiple assignments competently, accurately, and efficiently • Effective communications, organizational, and interpersonal skills • High School Diploma or GED • DG system claims processing experience preferred • Associate degree 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 • Eligibility for CVS Health bonus, commission or short-term incentive program in addition to base pay

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