[Remote] Claims Processing - Representative I

Note: The job is a remote job and is open to candidates in USA. CVS Health is dedicated to building a world of health around every individual, creating a connected and compassionate health experience. The Claims Processing - Representative I role involves reviewing claim documentation, verifying policy coverage, and ensuring accurate claims processing while providing customer service support.

Responsibilities

• Receives and monitors the completeness and accuracy of claims forms and supporting documentation submitted by healthcare providers
• Enters claim information, such as patient information, provider details, procedure codes, and diagnosis codes, into the company's claims processing system
• Documents relevant information for the eligibility of the claim, determining coverage and benefits, and assessing the validity and medical necessity of the services rendered
• Calculates claim payments based on the approved reimbursement rates, fee schedules, or contracted rates with healthcare providers
• Communicates claim status updates to healthcare providers, policyholders, or other stakeholders to provide transparency and ensure any additional information is resolved quickly
• Assists in resolving discrepancies or issues related to claims by researching and investigating claim-related inquiries, collaborating with internal teams or departments, and coordinating with healthcare providers to resolve claim processing errors or discrepancies
• Provides customer service support by addressing inquiries and resolving issues related to claims processing
• Ensures that all claims processing details and notes are inputted into the company systems database
• Assists in data entry tasks related to claims data management, such as updating claim statuses, maintaining accurate records, or ensuring proper documentation of claims processing activities

Skills

• 1 year work experience in Customer Service/ Data Entry in Healthcare
• Experience using Microsoft Office Suite (Outlook, Teams, Word, etc.)
• Working knowledge of problem solving and decision making skills
• Certified Billing and Coding Specialist (CBCS) preferred
• Intermediate experience using Microsoft Excel

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

Company Overview