Claim Benefit Specialist, CVS Health

Job Description:

This is a Claim Benefit Specialist work-from-home opportunity for candidates in the CST and PST time zones.

• Reviews and adjudicates routine claims in accordance with claim processing guidelines.
• Analyzes and approves routine claims that cannot be auto adjudicated.
• Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
• Routes and triages complex claims to Senior Claim Benefits Specialist.
• Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.

Required Qualifications

• Experience in a production environment.
• Medical claim processing experience preferred but not required.
• Medical coding background a plus but is not required.
• Ability to work independently.
• Ability to think logically and problem solve.
• Strong oral communication skill.

Preferred Qualifications

• Computer knowledge with experience with Outlook, EXCEL and Word

Education

• High School diploma, G.E.D. or equivalent experience.

Locations: ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, WA, OR, CA, NV

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