Claim Benefit Specialist
| Company | CVS Health |
|---|---|
| Location | Pennsylvania, USA |
| Salary | $17 – $28.46 |
| Type | Full-Time |
| Degrees | |
| Experience Level | Entry Level/New Grad, Junior |
Requirements
- Experience in a production environment
- Detailed and quality oriented
- Ability to research and work within several computer applications simultaneously
- Microsoft Outlook
Responsibilities
- Reviews and adjudicates routine Medicare claims on HRP system in accordance with claim processing guidelines
- 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
- 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
- Manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters
- Utilizes all applicable system functions available ensuring accurate and timely claim processing
Preferred Qualifications
- Claim processing experience
- Computer Navigation Proficiency
- Production & Quality background
- Microsoft Office tools