Claims Processing - Representative III

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

CVS Health is looking for a Claims Processors to join our fast-paced Claims Department. As a Claims Processor, you will be responsible for accurate and efficient adjudication of paper claims from electronic image in a production environment.

Primary Responsibilities of the Claims Processor include

• Processing and adjudicating member/pharmacy/prescriber submitted paper claims for our FEP line of business.

• Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.

• Accurately resolving pending claims using state and federal regulations and specific health plan criteria.

• Working within turnaround times to meet client performance guarantees for claims processing.

• Meeting productivity and accuracy standards.

• Team-oriented while also able to pursue personal and departmental production goals daily.

• Work internally submitted cases on a consistent basis and manage their case load (Account Manager/Care Requests).

• VH Holds, live checks, SPI requests, refund recovery, and dual payee chargebacks.

• Managing the team email box by ensuring fax claims are being auto-imported, inquiries are being researched, and import claim processing requests and assign out for review/handling.

• Ability to review adjudicated claims for errors and provide feedback to the processor.

Required Qualifications

At least 1 year of work experience that shows a progressive trend in responsibility and accountability preferably in a Healthcare setting

• 1+ year of experience Microsoft Word, Excel, and Outlook software.

• Previous claims processing experience.

• Excellent verbal and written communication skills.

• Strong typing skills with speed and accuracy.

• Ability to organize in a multi-demand and multi-priority environment.

Preferred Qualifications

Previous PBM experience.

• Ability to work overtime as necessary.

Education

HS or GED

Pay Range

The typical pay range for this role is

$17.00 - $25.65

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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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: 11/22/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.