Description
CVS Health is seeking a highly motivated Medical/Hospital Claim Processor for Rework Projects to join our Commercial Services Operations team. You will review and rework sensitive, complex medical and hospital claims for our rework project department, providing root cause analysis and precise resolution of affected claims.
Responsibilities
- Review and rework complex medical and hospital claims for accuracy and resolution
- Provide root cause analysis and precise resolution of affected claims
- Interface with appropriate areas to ensure claims are resolved accurately and on time
- Meet quality and turnaround time expectations
Requirements
- Minimum 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a related healthcare administrative role
- Strong analytical and problem-solving skills
- Proven ability to manage multiple priorities while meeting quality and turnaround time expectations
- Strong attention to detail and commitment to accuracy
- Proficiency in Microsoft Excel, including sorting, filtering, and basic data analysis
- Demonstrated ability to work effectively in a fast-paced environment while adapting to changing business needs
Preferred Qualifications
- Experience working in healthcare, insurance, claims processing, medical billing, or customer service
- Knowledge of medical terminology, insurance benefits, or healthcare operations
- Experience using computer systems to research and resolve customer or claim-related issues
- Ability to work independently and collaboratively in a team environment
- Strong organizational and time management skills
- Demonstrated adaptability and willingness to learn new processes and systems
Benefits
- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources
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