CVS Health
Job Type: Fully remote
Salary: 18.50 – 34.60 /hour
*Position is anywhere in US
The Senior Claims Benefits Specialist Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.
Additional responsibilities include but not limited to the following:
-Acts as a subject matter expert by providing training, coaching, or responding to complex issues
-Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise
-Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process
-Ensures all compliance requirements are satisfied and that all payments are made against company practices and procedures
-Identifies and reports possible claim over payments, underpayments and any other irregularities
-Performs claim re-work calculations
-Distributes work assignments daily to junior staff
-Trains and mentors claim benefit specialists
-Makes outbound calls to obtain required information for First claim or re-consideration
-Works with Health Plan Operations and within the State Encounter system to research and resolve errors
Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
– 2+ years Medical Claim processing experience
– Experience in a production environment
– Demonstrated ability to handle multiple assignments competently, accurately and efficiently
Preferred Qualifications
– Experience in updating or developing standard operating procedures when new edits presented
– Medicaid claims experience preferred
Education
Associates degree or equivalent work experience