Easter Seals Jobs

Bring your heart to CVS Health. Every 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.

A Brief Overview

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

What you will do

• Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.

• Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.

• Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.

• Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.

• Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.

• Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.

• Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.

• Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

• Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.

Position Summary

This is a Claim Benefit Specialist position and will be trained for 20 weeks virtually.

• Training: 20 weeks – 8-4:30pmEST

• Shift hours: flex schedule starting at 8AM EST will be offered after training.

• Reviews and adjudicates claims in accordance with claim processing guidelines.

• Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.

• Review claims 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.

• Analyzes and processes rework claims that cannot be auto adjudicated.

• In accordance with prescribed operational guidelines, manages route list/queues.

• Utilizes all applicable system functions available ensuring accurate and timely claim processing service.

Required Qualifications

• 1-2 years experience working in Customer Service.

• Possess strong teamwork and organizational skills

• Strong and effective communication skills

• Ability to handle multiple assignments competently through use of time management, accurately and efficiently

Preferred Qualifications

• Experience in a production environment.

• Healthcare experience.

• Knowledge of utilizing multiple systems at once to resolve complex issues.

• Claim processing experience preferred but not required.

• Understanding of medical terminology.

Education

• High School diploma, GED or equivalent Experience

Pay Range

The typical pay range for this role is:

$17.00 - $25.65

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 12/31/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.