Claim Benefit Specialist
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. Position Summary Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing members and providers with high quality claim adjudication. May handle customer service inquiries and problems. This role is fully onsite at 261 North University Dr, Plantation FL.
Requirements
- Applicant must have at least 2 years of experience in the following areas:
- Proficient in basic computer operations and software applications
- Experience working in a production- driven environment.
- Demonstrated ability to handle multiple assignments efficiently, accurately and efficiently.
- Strong oral and written communication abilities.
Nice To Haves
- Applies medical necessity guidelines, identifies discrepancies, and applies all cost containment. Measures to assist in the claim adjudication process.
- Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures.
- Identifies and reports possible claim overpayments, underpayments and any other irregularities.
- Performs claim rework calculations.
- Ensures accurate and timely claims processing
- Familiarity with medical terminology.
- Hands on experience in end-to-end medical claims processing.
Responsibilities
- Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.
- Acts as a subject matter expert by providing members and providers with high quality claim adjudication.
- May handle customer service inquiries and problems.
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
- For more information, visit https://jobs.cvshealth.com/us/en/benefits
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
