Claim Benefit Specialist Ops
CVS Pharmacy - Fresno, CA
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Job DescriptionThis is a Claim Benefit Specialist work from home opportunity for candidates in the CST and PST time zones. Reviews and adjudicates routine claims in accordance with claim processing guidelines. Analyzes and approves routine claims that cannot be auto adjudicated. Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies 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.Pay RangeThe typical pay range for this role is:Minimum: 17.00Maximum: 27.90Please 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 QualificationsExperience in a production environment. Medical claim processing experience preferred but not required. Medical coding background a plus but is not required. Ability to work independently. Ability to think logically and problem solve. Strong oral communication skill.Preferred QualificationsBackground in health insurance or medical billing preferred but not requiredEducationHigh School diploma, G.E.D. or equivalent experience.Business OverviewBring 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.
Created: 2024-09-07