Job Information
CVS Health Claim Benefit Specialist in Raleigh, North Carolina
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
This is a Claim Benefit Specialist position and will be trained for 20 weeks virtually.
Salary- $17.50 per hour
Training: 20 weeks – 8-4:30pmEST
Shift hours: flex schedule starting at 9am will be offered after training.
Reviews and adjudicates claims in accordance with claim processing guidelines.
Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
Review claims 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.
Analyzes and processes rework claims that cannot be auto adjudicated.
-In accordance with prescribed operational guidelines, manages route list/queues.
-Utilizes all applicable system functions available ensuring accurate and timely claim processing service
Required Qualifications
1-2 years experience working in Customer Service or Call Center environment.
Ability to handle multiple assignments competently through use of time management, accurately and efficiently.
Preferred Qualifications
Experience in a production environment.
Knowledge of utilizing multiple systems at once to resolve complex issues.
Healthcare experience.
Claim processing experience preferred.
Understanding of medical terminology
Strong and effective communication skills.
Possess strong teamwork and organizational skills
Education
High School diploma, GED or equivalent Experience
Pay Range
The typical pay range for this role is:
$17.00 - $25.65
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. 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 jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 06/21/2024
We are an equal opportunity and affirmative action employer. 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.