Senior Claims Benefit Specialist – Checkwork, Refund
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Claims Benefit Specialist processing medical claims and refunds for CVS Health. Researching, resolving, and adjudicating complex medical claims while ensuring compliance and accuracy.
Responsibilities:
- Review and complete provider solicited and unsolicited overpayment refunds and returned checks
- Research, resolve, and adjudicate complex, sensitive, and/or specialized medical claims
- Collaborate and partner with key business functions to ensure accuracy in posting overpayment refunds
- Process complex non-routine Provider Refunds and Returned Checks
- Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid
- Apply medical necessity guidelines, determine coverage, complete eligibility verification
- Ensure compliance requirements are satisfied
- Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals
- Review and handle relevant claims data mining work assigned to the team
Requirements:
- 2+ years medical claim processing experience
- 2+ experience in a production environment
- 1+ years processing medical claims adjustments/rework
- Experience reviewing and researching overpayment refunds
- DG system claims processing experience
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently
- Effective communications, organizational, and interpersonal skills
- Familiarity with overpayment recovery
- Associate degree or equivalent experience
Benefits:
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
- Many other benefits depending on eligibility
Similar Jobs
1st Level Global Help Desk, m/w/d
1st Level Global Help Desk role at CANCOM assisting with IT issues and inquiries. Focused on sustainable solutions and efficient ticket management within a supportive team environment.
IT Support Specialist II
IT Support Specialist II at D-Wave Quantum providing high-quality technical support and managing IT systems. Collaborating with IT teams to enhance service delivery and troubleshooting complex issues.
Part-Time IT Support Assistant
IT Support Desk Analyst serving as the first point of contact for IT support. Looking for dependability and customer-focus with a desire to grow in IT.
Technical Customer Support Advocate
Technical Customer Support Advocate optimizing support operations through AI and automation at Procurify. Bridging customer feedback to influence product development and enhance user experience.
IT Engineer – Automation
IT Engineer role focused on smart automation and system management for a remote team aiming to innovate in health and wellness. Contribute to building reliable systems that enhance productivity and security.
IT Manager
IT Manager leading support teams for TaskUs, managing technology service deliveries. Responsible for ensuring technology functions effectively for clients across the globe.
Help Desk Agent
Help Desk Agent supporting customers and technicians with vehicle telematics systems at Federated Service Solutions. Engaging in troubleshooting vehicle installations and managing various informational tasks.
Audit Manager – Healthcare
Audit Manager leading Healthcare engagements at AAFCPAs. Responsible for supervising teams and ensuring adherence to high audit standards in healthcare.
Lead Enterprise Architect – Productivity
Lead Enterprise Architect overseeing technology financial management at Humana. Driving cost transparency and productivity improvements through effective collaboration and strategic leadership.
Associate Director, IT Infrastructure Operations – Process Improvement
Associate Director overseeing IT Infrastructure Operations and Process Improvement at Humana. Responsible for optimizing performance and ensuring operational excellence across systems and resources.
AR Credit Administrator
AR Credit Administrator reviewing and processing credit applications for Lithia & Driveway. Ensuring compliance and providing customer insights while maintaining accurate records.
IT Support Administrator
IT Support Administrator responsible for technology support in a healthcare company. Maintaining systems, automating processes, and ensuring team productivity in a remote setup.
IT Specialist
IT Specialist providing 100% remote support to a global team; resolving tickets and ensuring system integrity.
IT Engineer
Onsite IT Engineer providing technical support to healthcare clients in Vero Beach, FL. Collaborating with executive teams and leading infrastructure improvements in Managed Service Provider context.
Principal Technical Program Manager – Core Services, Enterprise Architecture
Principal Technical Program Manager overseeing Core Services and Enterprise Architecture for Allegion. Leading cross-functional teams and driving technical roadmaps to enhance security technology solutions.
Helpdesk / IT Support – Specialist
Service Desk Mitarbeiter providing IT support and ensuring communication for business clients in a remote role. Position involves troubleshooting, ticketing, and client communication for technical issues.
IT Support Analyst, Junior
Support Analyst for IT infrastructure focusing on quality service and improvements. Engaging in preventive actions and collaboration with the technical support team in a remote setting.
Technical Customer Support Specialist
Technical Support Specialist providing technical assistance for marketing analytics platform. Collaborating with customers remotely to resolve issues and offer guidance in using the platform.
Helpdesk Engineer
Helpdesk Engineer providing tech support and onboarding for CyberSheath's Managed Services clients. Working on project tasks related to system administration and cloud solutions in a virtual environment.
Area Credit Manager
Area Credit Manager overseeing accounts receivable portfolio for SRS Distribution. Ensuring timely collections, processing credit applications, and collaborating internally and externally.