Paper Claims Processor I

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

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

REQUIRED QUALIFICATIONS

• 6 months work experience Customer Service, Health Care, Medical, and/or Administrative Assistant
• Demonstrated experience and knowledge using Microsoft Office Suite (Word, Excel, Outlook, Teams, and PowerPoint)
• Working knowledge of problem solving and decision making skills

PREFERRED QUALIFICATIONS

• Certified Billing and Coding Specialist (CBCS) preferred.

EDUCATION

High School Diploma or equivalent General Education Development (GED)

• Receives and monitors the completeness and accuracy of claims forms and supporting documentation submitted by healthcare providers.
• Enters claim information, such as patient information, provider details, procedure codes, and diagnosis codes, into the company’s claims processing system.
• Documents relevant information for the eligibility of the claim, determining coverage and benefits, and assessing the validity and medical necessity of the services rendered.
• Calculates claim payments based on the approved reimbursement rates, fee schedules, or contracted rates with healthcare providers.
• Communicates claim status updates to healthcare providers, policyholders, or other stakeholders to provide transparency and ensure any additional information is resolved quickly.
• Assists in resolving discrepancies or issues related to claims by researching and investigating claim-related inquiries, collaborating with internal teams or departments, and coordinating with healthcare providers to resolve claim processing errors or discrepancy
• Provides customer service support by addressing inquiries and resolving issues related to claims processing.
• Ensures that all claims processing details and notes are inputted into the company systems database.
• Assists in data entry tasks related to claims data management, such as updating claim statuses, maintaining accurate records, or ensuring proper documentation of claims processing activities.