Senior Claim Benefit Specialist – Checkwork, Refund

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🔥 0 minutes ago

🏈 Alabama, Arizona, +32 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – 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 ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote 🍑 Georgia – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• 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 complete provider-solicited and unsolicited overpayment refunds and returned checks • Research, resolve, and adjudicate complex, sensitive, and/or specialized medical claims • Partner with key business functions to ensure accurate posting of overpayment refunds • Reconcile discrepancies and respond to internal and provider inquiries • 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 across all dollar amounts • Resolve medical claim overpayments, underpayments, and other irregularities • Respond to 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 as assigned • Utilize resource materials and tools to manage responsibilities • Handle assigned customer service inquiries and issues

🎯 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 • Preferred: experience reviewing and researching overpayment refunds • Preferred: DG system claims processing experience • Preferred: ability to manage multiple assignments accurately and efficiently • Preferred: effective communication, organizational, and interpersonal skills • Preferred: familiarity with overpayment recovery processes

🏖️ Benefits

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

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