Job Description
Title: Claims Processing Representative I
Location: Phoenix AZ US
Category: Plan Operations
Job Type: Fully remote
Salary: 17.00 – 27.90
Job Description:
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 experienced 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. Commercial Paper Claims processes an average of 74,000 claims monthly, and provides service to multiple employer and health plans.
Primary Responsibilities of the Claims Processor include:
– Processing and adjudicating commercial paper claims.
– 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.
– Making outreach to pharmacies by phone to request information that may be missing in a submission
Required Qualifications
-1+ year of claims experience (medical or dental claims experience will be considered)
-1+ year of experience Microsoft Word, Excel and Outlook software
Preferred Qualifications
-Previous PBM Experience
– Strong typing skills with speed and accuracy
– Team-oriented while also able to pursue personal and departmental production goals daily
– Ability to organize in a multi-demand and multi-priority environment
– Ability to work overtime as necessary
Education
High School Diploma or GED required