Medical Claims Support

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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything we do.

Job Overview Inspects and provides accurate claim information to support savings optimization for claims. Responds to customers on benefit inquiries. Maintains customer service standards. Administers policies and procedures for medical cost management. Coordinates support functions for claim adjudication.

Responsibilities

• Executes routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews ECHS report daily for distribution of tasks to appeal nurses.
• Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician.
• Using CS Hub guidelines, reviews and processes predetermination requests to determine review eligibility.
• Processes CORR tasks to work or reroute as appropriate.
• Prioritizes work and multitasks to balance projected workload and due dates.

Requirements

• Working knowledge of problem-solving and decision-making skills.
• 5+ years of work experience.
• High school diploma or equivalent required.

Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Pay Range $18.50 - $38.82 per hour.