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About the Role
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Responsibilities
- Inspects and provides accurate claim information to support savings optimization for claims.
- Responds to customers on benefit inquiries.
- Maintains customer service standards.
- Administers policies and procedures for medical cost management.
- Coordinates support functions for claim adjudication.
- Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers.
- Follows area protocols, standards, and policies to provide effective and timely support.
- Review ECHS report daily for distribution of tasks to appeal nurses.
- Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician.
- Using CS Hub guidelines, review, and process predetermination requests to determine review eligibility.
- Process CORR tasks to work or reroute as appropriate.
- Prioritize work and multitasks to balance projected workload and due dates.
Requirements
- Working knowledge of problem solving and decision-making skills
- 5+ years of work experience
Work Type
- Full time
Experience Level
- 5+ years of work experience
Education Level
- High school diploma or equivalent required.
Salary/Compensations
- $18.50 - $38.82
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
About the Company
- Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Equal Opportunity
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.