Claims Benefit Specialist- Life Claims
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 Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with funeral homes, beneficiaries and family members, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of final expense claims for reimbursement through knowledge of life claims processes and effective communication skills. Job Description Handles and processes final expense claims submitted by beneficiaries, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Documents claim information in the company system, assigning necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with funeral homes, beneficiaries, family members, or other stakeholders to resolve any discrepancies or issues related to claims. Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies. Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development. Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Conducts outbound calls on an as needed bases to respective parties
Requirements
- Must report into Franklin, TN office Tuesday- Thursday
- 1+ years experience in a high production environment
- Experience with Microsoft Office (specifically Excel)
- Ability to review and triage documents to the correct location
- Ability to multi-task, prioritize, & handle multiple workloads/assignments
- Ability to collaborate with team members to resolve any issues
Nice To Haves
- 1-2 years Experience in a final expense claims processing environment
Responsibilities
- Handles and processes final expense claims submitted by beneficiaries, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
- Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
- Documents claim information in the company system, assigning necessary data elements to ensure accurate tracking, reporting, and processing of claims.
- Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
- Communicates with funeral homes, beneficiaries, family members, or other stakeholders to resolve any discrepancies or issues related to claims.
- Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.
- Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
- Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
- Conducts outbound calls on an as needed bases to respective parties
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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
