This position is permanent work from home for any candidate in
the EST time zone.
Reviews and adjudicates claims in accordance with claim
processing guidelines. Claim Benefit Specialists have the
opportunity to enhance and improve member satisfaction and
retention by providing accurate and timely resolution in processing
medical claims. You will be a key link in providing our customers
with prompt, efficient, high quality claim service.
- Determine and understand the coverage provided under a member's
- Efficiently use multiple systems and screens to obtain and
record claim information
- Review claims information to determine the nature of a member's
illness or injury
- Identify claim cost management opportunities and refer claims
for follow up
- Make claim payment decisions
- Process claims accurately to enhance customer satisfaction and
- Process claims within quality and production standards
- Assist team members in support of achieving team, office,
regional, and national goals
We are looking for a detail oriented individual who enjoys
working in a team environment and can create value for our
customers by exceeding high quality metrics. The ideal candidate
will have exceptional analytical skills, accurate and fast
keyboarding skills, advanced computer navigation and knowledge and
experience in a Windows environment, effective verbal and written
communication skills, the ability to adapt quickly and willingly to
change, and a positive, willing attitude. Prior medical claim
processing experience is a plus. Successful candidates should be
comfortable with quality goals, production goals, and service
expectations and will be monitored for accuracy, efficiency, and
customer satisfaction. Comprehensive training will be provided to
assist in the achievement of these objectives. Attendance during
the 20 week training period is required. After completion of the
training period, overtime may be required based on business
Experience in a quality and production environment.
Attention to detail.
Ability to use multiple computer applications at one time.
Claim processing experience.
High School diploma, G.E.D. or equivalent experience
Associates Degree preferred
At Aetna, a CVS Health company, we are joined in a common
purpose: helping people on their path to better health. We are
working to transform health care through innovations that make
quality care more accessible, easier to use, less expensive and
patient-focused. Working together and organizing around the
individual, we are pioneering a new approach to total health that
puts people at the heart.
We are committed to maintaining a diverse and inclusive
workplace. CVS Health is an equal opportunity and affirmative
action employer. We do not discriminate in recruiting, hiring or
promotion based on race, ethnicity, gender, gender identity, age,
disability or protected veteran status. We proudly support and
encourage people with military experience (active, veterans,
reservists and National Guard) as well as military spouses to apply
for CVS Health job opportunities.