specialized claims in accordance with claim processing guidelines.
Demonstrated ability to handle multiple assignments

competently, accurately and efficiently.

Reviews and adjudicates routine claims in accordance with claim processing guidelines.

Critical success factors:

- Ability to work independently

- Ability to think logically and problem solve

- Strong oral communication skills.

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.

Determine and understand the coverage provided under
a member's health plan
Efficiently use multiple systems and screens to obtain
and record claim information
Review claims information to determine the nature of a
member's illness or injury
Identify claim cost management opportunities and refer
claims for follow up
Make claim payment decisions
Process claims accurately to enhance customer
satisfaction and retention
Process claims within quality and production standards
Assist team members in support of achieving team,
office, regional, and national goals

Required Qualifications

Experience in a production environment.

Medical claim processing experience preferred but not required.

Medical coding background a plus but is not required

Preferred Qualifications
Experience with Excel, Word, Teams and Outlook.

Education

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

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/04/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.