Claim Benefit Specialist OPS

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

About the role

Processing Medicare claims on the HRP-HealthEdge Platform. The Claim Benefit Specialist position is a production-based role servicing Medicare Advantage beneficiaries.

• Reviews and adjudicates Medicare medical claims in accordance with CMS claim processing guidelines.
• Role requires strong keyboard skills, attention to detail and the ability to work independently in a production environment.
• Note: Our CBS positions in Medicare are not limited to Front-End Claims. These positions can support various Medicare workstreams as determined by business need. This can be either FE Claims, Specialty work or our Rework team.

Responsibilities

• Experience in a production-based environment with an emphasis on quality outcomes.
• Medical Claim processing experience preferably supporting Medicare products.
• Strong computer navigational skills.

Requirements

• 1 year experience in a production environment.
• Detailed and quality oriented.
• Ability to research and work within several computer applications simultaneously.
• Microsoft Outlook.
• High School Diploma or equivalent GED.

Preferred Qualifications

• Claim processing experience.
• Computer Navigation Proficiency.
• Production & Quality background.
• Microsoft Office tools.
• Medical terminology and coding certification.

Pay

The typical pay range for this role is $17.00 - $28.46 per hour. This pay range represents the base hourly rate 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.

Schedule

• Anticipated weekly hours: 40
• Time type: Full time

Benefits

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.