Senior Claim Benefit Specialist - Operations

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 The Senior Claim Benefit Specialist (OPS) reviews, researches and adjudicates complex, sensitive, and/or specialized encounters in accordance with State driven encounter processing guidelines. May be required to learn multiple Medicaid plans. Medical claims processing experience is a basic requirement. ? Works to research and resolve encounter errors ? Ensures all compliance requirements are met. ? Identifies and reports possible claim overpayments, underpayments, scanning issues and any other irregularities. Required Qualifications 2 years Medical Claims processing experience (Commercial, Medicaid, Medicare, etc.) Experience in a production environment. Analytical skills, with the ability to research particularly in areas involving rejected claims. Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. Demonstrated proficiency with personal computer, keyboard navigation skills, and MS Office Suite applications Preferred Qualifications QNXT claims processing experience Encounters experience Edifecs knowledge Education High School Diploma or equivalent GED Pay Range The typical pay range for this role is: $18.50 - $31.72 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 Benefits | CVS Health We anticipate the application window for this opening will close on: 01/10/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

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