Claims Benefit Specialist CVS

CVS Health, the Woonsocket, Rhode Island-based healthcare company, offers clinical, retail pharmacy, specialty pharmacy, pharmacy benefit management, and prescription mail order services in the US, the District of Columbia, and Puerto Rico. CVS’ mission is to provide people assistance on their path to better health, making quality care more affordable, accessible, simple and seamless.The company seeks to attract individuals whose beliefs and behaviors are in alignment with CVS core values of collaboration, innovation, caring, integrity and accountability. The multi-award winning company [e.g. Military Friendly Employer, America’s Top Corporation for Women Business Enterprises] provides opportunities to a diverse work experience that empowers the team for career success. CVS offers a benefits package to its employees, including medical, prescription, dental and vision coverage, a company contribution to a health savings account [HSA], employee stock purchase plan, adoption benefits, life, accident and disability insurance, paid time off, tuition reimbursement, and colleague discount.

Job Description

Reviews and adjudicates Dental claims in accordance with claim processing guidelines.Analyzes and approves Dental claims that cannot be auto adjudicated.•Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.•Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.•In accordance with prescribed operational guidelines, route/queues, and ECHS within specified turn-around-time parameters [Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor].•Utilizes all applicable system functions available ensuring accurate and timely claim processing service [i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools].• Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.

Required Qualifications

Experience in a production environment.- Knowledge of utilizing multiple systems at once to resolve complex issues.- Claim processing experience preferred but not required.-Understanding of dental terminology

COVID Requirements

CVS Health requires its Colleagues to be fully vaccinated against COVID-19 [including any booster shots if required], where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Please see qualifications

Education

GED or High School Diploma

Business Overview

Bring your heart to CVS HealthEvery 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.

 This position is open. This job was posted on Sun Feb 20 2022 and expires on Tue Mar 22 2022.