Senior Claim Benefit Specialist, Operations

Job not on LinkedIn

🔥 2 hours ago

🏈 Alabama, Arizona, +38 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – 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 🦀 Maryland – 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 ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote 🍑 Georgia – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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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

• Research, review, and adjudicate complex, sensitive, and specialized encounters according to state-specific processing guidelines • Drive timely resolution of encounter errors using available resources, tools, and research • Adjudicate complex, sensitive, and specialized claims accurately in the claims processing system • Meet quality and production expectations • Identify and escalate issues affecting claim payment accuracy or creating rework • Partner cross-functionally to resolve barriers to encounter acceptance • Contribute to developing desktops and standardized procedures • Balance competing priorities while supporting multiple markets • Participate in working sessions and meetings advancing business objectives and KPIs

🎯 Requirements

• Minimum 2 years of medical claims processing experience (Commercial, Medicaid, Medicare) • Experience working in a production environment • Strong analytical and problem-solving skills, especially in researching claims • Proficiency in MS Office Suite applications; Excel, Word, OneNote • Ability to work independently and as a team • High School Diploma • QNXT or Facets claims processing experience (preferred) • Experience in Medicaid or Medicare claims (preferred) • Encounters experience (preferred) • Edifecs system knowledge (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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