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Senior Claim Benefit Specialist - Remote - Remote Eligible

Train and mentor junior specialists to enhance claim processing efficiency and accuracy.
Remote
Senior
$18.50 - $35.29 USD per hour
3 weeks ago
CVS Health

CVS Health

CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.

✨ About The Role

- The Senior Claim Benefit Specialist will review and adjudicate complex and sensitive claims according to established guidelines. - This role involves acting as a subject matter expert, providing training and coaching to junior staff members. - The specialist will handle customer service inquiries related to pre-approval, reconsiderations, and appeals. - Compliance with all requirements is crucial, ensuring that payments align with company practices and procedures. - The position includes distributing daily work assignments and making outbound calls to gather necessary information for claims.

âš¡ Requirements

- The ideal candidate will have at least 2 years of medical claim processing experience, demonstrating a solid understanding of the claims adjudication process. - Experience in a production environment is essential, indicating the ability to work efficiently under pressure. - The candidate should possess strong organizational skills to handle multiple assignments competently and accurately. - A background in self-funding and knowledge of DG systems is preferred, showcasing a deeper understanding of the claims landscape. - The successful individual will be proactive in identifying discrepancies and reporting irregularities in claims processing.
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Senior Claim Benefit Specialist - Remote - Remote Eligible
Remote
$18.50 - $35.29 USD per hour
Remote
About CVS Health
CVS Health is a leading pharmacy and healthcare company offering prescriptions, products, and wellness services.