Claim Benefit Specialist

CVS Health

2d•Remote

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 - Attendance during the 21 week training period is required. - Applicants must reside in the Eastern Standard time zone (EST). Claim Benefit Specialist Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service. Determine and understand the coverage provided under a member's health plan Efficiently use multiple systems and screens to obtain and record claim information Review claims information to determine the nature of a member's illness or injury Identify claim cost management opportunities and refer claims for follow up Make claim payment decisions Process claims accurately to enhance customer satisfaction and retention Process claims within quality and production standards Assist team members in support of achieving team, office, regional, and national goals

Requirements

Experience in a quality and production environment.
Attention to detail.
Ability to use multiple computer applications at one time.
Claim processing experience.
Attendance during the 21 week training period is required.
Applicants must reside in the Eastern Standard time zone (EST).

Nice To Haves

Associate’s degree
Detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics.
Exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment, effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive, willing attitude.
Prior medical claim processing experience is a plus.
Comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction.

Responsibilities

Reviews and adjudicates claims in accordance with claim processing guidelines.
Enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims.
Determine and understand the coverage provided under a member's health plan.
Efficiently use multiple systems and screens to obtain and record claim information.
Review claims information to determine the nature of a member's illness or injury.
Identify claim cost management opportunities and refer claims for follow up.
Make claim payment decisions.
Process claims accurately to enhance customer satisfaction and retention.
Process claims within quality and production standards.
Assist team members in support of achieving team, office, regional, and national goals.