Claim Benefit Specialist OPS
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 Processing Medicare claims on the HRP-HealthEdge Platform The Claim Benefit Specialist position is a production-based role servicing Medicare Advantage beneficiaries. Additional responsibilities to include but not limited to the following: Reviews and adjudicates Medicare medical claims in accordance with CMS claim processing guidelines. Role requires strong keyboard skills, attention to detail and the ability to work independently in a production environment. Experience in a production based environment with an emphasis on quality outcomes. Medical Claim processing experience preferably supporting Medicare products. Strong computer navigational skills. Medical terminology and coding certification. Note: Our CBS positions in Medicare are not limited to Front-End Claims. These positions can support various Medicare workstreams as determined by business need. This can be either FE Claims, Specialty work or our Rework team.-
Requirements
- 1 year Experience in a production environment
- Detailed and quality oriented
- Ability to research and work within several computer applications simultaneously
- Microsoft Outlook
- Strong keyboard skills
- Attention to detail
- Ability to work independently in a production environment
- Experience in a production based environment with an emphasis on quality outcomes
- Medical Claim processing experience preferably supporting Medicare products
- Strong computer navigational skills
- Medical terminology and coding certification
Nice To Haves
- Claim processing experience
- Computer Navigation Proficiency
- Production & Quality background
- Microsoft Office tools
Responsibilities
- Processing Medicare claims on the HRP-HealthEdge Platform
- Reviews and adjudicates Medicare medical claims in accordance with CMS claim processing guidelines
- Support various Medicare workstreams as determined by business need (FE Claims, Specialty work, or Rework team)
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
