CVS Health Hiring for Claim Benefit Specialist – Work from Home at Virginia Full Time

Reviews and adjudicates claims for individual family plans.

Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service.

• 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

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Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90

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
Required Qualifications :
Attendance during the 20 week training period is required.
Experience in a quality and production environment.

Attention to detail.

Ability to use multiple computer applications at one time.

Claim processing experience.

Analyzes and approves routine claims that cannot be auto adjudicated.
Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify 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.
May facilitate training when considered topic subject matter expert.
Utilizes all applicable system functions available ensuring accurate and timely claim processing service.

Preferred Qualifications
Strong oral and written communication skills.
Ability to maintain accuracy and production standards.
Technical skills.
Attention to detail and accuracy.
Analytical skills.
Ability to Multi-Task

Education
High School Diploma or GED equivalent

Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.