Claim Benefit Specialist

CVS Health•Hartford, CT

3d•Onsite

About The Position

CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. They will work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims. The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date. The candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns.

Requirements

Minimum 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a related healthcare administrative role.
Strong analytical and problem-solving skills with the ability to research and resolve complex claim issues.
Proven ability to manage multiple priorities while meeting quality and turnaround time expectations.
Strong attention to detail and commitment to accuracy.
Proficiency in Microsoft Excel, including sorting, filtering, and basic data analysis.
Demonstrated ability to work effectively in a fast-paced environment while adapting to changing business needs.

Nice To Haves

Experience working in healthcare, insurance, claims processing, medical billing, or customer service.
Knowledge of medical terminology, insurance benefits, or healthcare operations.
Experience using computer systems to research and resolve customer or claim-related issues.
Ability to work independently and collaboratively in a team environment.
Strong organizational and time management skills.
Demonstrated adaptability and willingness to learn new processes and systems.

Responsibilities

Review and rework sensitive, complex medical and hospital claims for the rework project department.
Provide root cause analysis and precise resolution of affected claims.
Ensure rework project claims are resolved accurately, interface with appropriate areas, and are handled by the rework project due date.
Serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects.