Senior Claim Benefit Specialist Operations (Encounters)

CVS Health • New York, NV

1d • $19 - $35

About The Position

The Senior Claim Benefit Specialist (Encounter Corrections Analyst) researches, reviews, and adjudicates complex, sensitive, and specialized encounters in accordance with state-specific processing guidelines. The role requires medical claims processing experience and may support multiple Medicaid plans. Specialists correct encounters accurately and efficiently in a fast-paced production environment.

Requirements

• At least 2 years of medical claims processing experience in Commercial, Medicaid, or Medicare.
• Experience working in a production environment.
• Strong analytical and problem-solving skills, especially in researching claims.
• Proficiency in MS Office Suite applications, including Excel, Word, and OneNote.
• Ability to work independently and as part of a team.
• High school diploma.

Nice To Haves

• QNXT or Facets claims processing experience.
• Experience in Medicaid or Medicare claims.
• Encounters experience.
• Edifecs system knowledge.

Responsibilities

• Drive timely resolution of encounter errors using available resources, tools, and research.
• Adjudicate complex, sensitive, and specialized claims accurately in the claims processing system.
• Meet quality and production expectations consistently.
• Identify and escalate issues that impact claim payment accuracy or create rework.
• Partner cross-functionally to resolve barriers to encounter acceptance.
• Contribute to the development of desktops and standardized procedures.
• Balance competing priorities while supporting multiple markets.
• Participate in working sessions and meetings that advance business objectives and Key Performance Indicators (KPI).

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being, based on eligibility

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED