Claims Processor

Job Summary

This Claims Processor role is an exciting opportunity to join the CVS Health team and contribute to the delivery of enhanced human-centric healthcare. As a Claims Processor, you will be responsible for accurate and efficient adjudication of paper claims from electronic images in a production environment.

Key Responsibilities

Outbound calls to Members and/or Providers for verification of information
Processing and adjudicating paper claims
Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures
Accurately resolving pending claims using state and federal regulations and specific health plan criteria
Working within turnaround times to meet client performance guarantees for claims processing
Meeting productivity and accuracy standards

Requirements

At least 1 year of work experience that shows a progressive trend in responsibility and accountability preferably in a Healthcare setting
Excellent verbal and written communication skills
In-depth experience working with Microsoft Office Suite products

Preferred Qualifications

Call center type experience
Previous PBM Experience
Strong typing skills with speed and accuracy
Team-oriented while also able to pursue personal and departmental production goals daily
Ability to stay organized in a multi-demand and multi-priority environment
Ability to work overtime as necessary

Benefits

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and an Employee Stock Purchase Plan. Additionally, eligible employees may participate in the Company's 401(k) retirement savings plan and an Employee Stock Purchase Plan. 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.

---