Claim Benefit Specialist – Work from Home

This is a work from home opportunity for candidates based in the EST time zone.

Schedule:
Training Schedule: 20-21 weeks ( NO PTO during training)

Shift Schedule: EST 8:am- 4:30pmEST

We are looking for a detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics.

• Reviews and adjudicates claims in accordance with claim processing guidelines.

• Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims.

• You will be a key link in providing our customers with prompt, efficient, high quality claim service.

• Determine and understand the coverage provided under a member’s health plan.

• Efficiently use multiple systems and screens to obtain and record claim information.

• Review claims information to determine the nature of a member’s illness or injury.

• Identify claim cost management opportunities and refer claims for follow up.

• Make claim payment decisions

• Process claims accurately to enhance customer satisfaction and retention.

• Process claims within quality and production standards

• Assist team members in support of achieving team, office, regional, and national goals

Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90

Please 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 Qualifications

• The ideal candidate will have exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment, effective verbal and written communication skills, the ability to adapt quickly and willingly to change, and a positive, willing attitude.

• Prior medical claim processing experience is a plus.

• Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction.

• Comprehensive training will be provided to assist in the achievement of these objectives. Attendance during the 20 week training period is required. After completion of the training period, overtime may be required based on business needs.

Preferred Qualifications
See above

Education
Associate’s degree preferred; High School diploma required

Business Overview
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. 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.