Senior Claims Benefit Specialist – Checkwork, Refund
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Mississippi • Montana • United States
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Salary
💰 $19 - $42 per hour
Job Level
About the role
- Review and complete provider solicited and unsolicited overpayment refunds and returned checks
- Research, resolve, and adjudicate complex, sensitive, and/or specialized medical claims
- Collaborate and partner with key business functions to ensure accuracy in posting overpayment refunds
- Process complex non-routine Provider Refunds and Returned Checks
- Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid
- Apply medical necessity guidelines, determine coverage, complete eligibility verification
- Ensure compliance requirements are satisfied
- Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals
- Review and handle relevant claims data mining work assigned to the team
Requirements
- 2+ years medical claim processing experience
- 2+ experience in a production environment
- 1+ years processing medical claims adjustments/rework
- Experience reviewing and researching overpayment refunds
- DG system claims processing experience
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently
- Effective communications, organizational, and interpersonal skills
- Familiarity with overpayment recovery
- Associate degree or equivalent experience
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical claim processingclaims adjustmentsoverpayment refundsdata miningeligibility verificationmedical necessity guidelinescontract interpretationcompliance requirementspre-approvalspre-authorizations
Soft Skills
effective communicationorganizational skillsinterpersonal skillsability to handle multiple assignmentsaccuracyefficiency
Certifications
Associate degree