Claim Benefit Specialist

CVS Health•Work At Home-Texas, TX

2d•$17 - $28

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. - Attendance during the 21 week training period is required. After completion of the training period, overtime may be required based on business needs. - Applicants must reside in Central Standard Time Zone (CST), Mountain Standard Time (MST) or Pacific Standard Time (PST) Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

Requirements

Proficient in computer operations and software applications
Experience in a production environment.
Ability to performance metrics including production, quality, and turnaround time.
Possess strong teamwork and organizational skills.
Reside in Central Standard Time Zone (CST), Mountain Standard Time (MST) or Pacific Standard Time (PST)

Nice To Haves

Ability to multi-task
Ability to work independently or as part of a group

Responsibilities

Handles and processes claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.
Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.