Claim Benefit Specialist

at  CVS Health

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

We are looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. The candidates will review and adjudicate claims in accordance with ACAS claim processing guidelines. They will work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims.
The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date. They must be detail-oriented, quality minded, be a team player, and meet expected results.
The candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns.

REQUIRED QUALIFICATIONS

• Experience in a production environment.
• Proven ability to provide excellent service by meeting key performance metrics including production, quality, and turnaround time.
• Possess strong teamwork and organizational skills.
• Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

PREFERRED QUALIFICATIONS

• ACAS claim system experience.
• Detail oriented, root cause problem solving, organized and able to manage multiple priorities.

EDUCATION

• High School Diploma.

Please refer the Job description for details