Claim Benefit Specialist

CVS Health•Washington, NV

1d•$17 - $31

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 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

1 year knowledge of Aetna claim and provider systems
Experience in a Medical claims/ billing background
Strong work ethic
Efficient and flexible
Proficient in Excel experience

Nice To Haves

Working knowledge of ACAS claim system, Excel, and Word
Ability to analyze data
Ability to work independently as well as part of the team, contributing to overall effectiveness of the team
Able to successfully cope with the high demands of the job while effectively maintaining personal composure
Initiative to improve personal performance as well as those of peers and team

Responsibilities

Effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department.
Work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims.
Ensure rework project claims are resolved accurately, interfaces with appropriate areas, and is 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 generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns.
Perform a detailed analysis and reworking complex claim issues.