Healthcare Claims Review Specialist

About CVS Wellbeing

At CVS Wellbeing, our mission is to improve healthcare for a rapidly changing world. We are driven by a commitment to deliver human-centered care, recognizing that how we deliver our services is as important as what we deliver. Our core values guide us in transforming lifestyles and accelerating our ability to provide accessible, convenient, and affordable healthcare.

Position Overview

• Location: Remote
• Start Date: Immediate openings available
• Compensation: Competitive salary ($25/hour)
• Company: CVS Wellbeing
• Position: Healthcare Claims Review Specialist

Responsibilities

• Review and triage assigned claims for accuracy and completeness.
• Determine coverage, verify eligibility, identify and resolve discrepancies.
• Prepare claim approvals and denials for review by clinical staff.
• Prioritize and manage workload to meet deadlines and quality standards.
• Communicate effectively with internal and external stakeholders to enhance the efficiency of clinical service delivery.
• Perform non-clinical research and support.
• Ensure compliance with PM strategies and regulatory standards.
• Maintain accurate and complete documentation to meet risk management, regulatory, and authorization requirements.
• Protect patient confidentiality and adhere to company privacy policies.
• Assist in the investigation and resolution of claim payment issues.

Qualifications

• Excellent communication, phone, and interpersonal skills.
• Knowledge of basic medical terminology and concepts.
• Strong customer service skills with an ability to resolve issues and promote positive patient outcomes.
• Proficiency in PC navigation, including Microsoft Excel and Word.
• Ability to collaborate effectively within a multidisciplinary team.

Preferred Qualifications

• 2-4 years of experience as a clinical partner, office assistant, or claims processor.
• Familiarity with ATV, ASD, and Med Compass systems.

Benefits

CVS Wellbeing offers a comprehensive benefits package, including medical, dental, and vision insurance, a 401(k) retirement savings plan, employee stock purchase plan, disaster insurance, short-term and long-term disability benefits, and various wellness programs. We also provide paid time off, holidays, and other time-off benefits in accordance with state regulations and company policies.

We encourage applications from individuals who demonstrate a strong work ethic and a willingness to learn. Apply today!