Sr Claim Benefit Specialist

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand ? with heart at its center ? our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors? support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Review and processes commercial medical and vision claims accordance with plan processing guidelines.

Required Qualifications

2+ years' experience in commercial medical claim processing. Knowledgeable in Rev Codes, CPT codes, HCPCS codes and Bill Types. Knowledgeable in professional medical bills with modifiers versus facility claims. Knowledgeable in coordination of benefits. Experience in managing multiple daily tasks with accuracy and efficiency.

Reviews plan documents and determines coverage, applies medical necessity guidelines, completes eligibility verification. Applies claims processing adjudication from start to finish.

Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures.

Preferred Qualifications

2+ years commercial medical claim processing and experience in CPT, REV, HCPCS codes and Bill Types.

Experience in production environment. Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

Education

Associates degree or in lieu of degree applicable work experience in commercial claims processing.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$18.50 - $35.29

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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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: 02/26/2025

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