Job description$1,000 sign on bonus and a $2,000 bonus after 90 days of successful training! The sign on and retention bonuses are not applicable to current internal employees of CVS or Aetna.
**Must be located within 50 miles of New Albany, OH** This is a Remote role.
- Reviews and adjudicates routine claims in accordance with claim processing guidelines.
- Analyzes and approves routine claims that cannot be auto adjudicated.
- Applies medical necessity guidelines, determines coverage, complete eligibly verification, identify discrepancies and applies all cost containment measures to assist in the claim adjudication process.
- Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues.
- Routes and triages complex claims to Senior Claim Benefits Specialist.
- Proofs claim or referral submission to determine, review or apply appropriate guidelines, coding, member identification process, diagnosis and pre-coding requirements.
- May facilitate training when considered topic subject matter expert.
- In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic correspondence Handling System - system used to process correspondence that is scanned in the system by a vendor).
- Utilizes all applicable system functions available ensuring accurate and timely claim processing services (i.e. utilizes claim check, reasonable and customary data, and other post-containment tools).
- Clear communication skills.
- Experience in a production based environment
- Claim processing experience
- Strategic thinking.
**Must be located within 50 miles of New Albany, OH** This is an in office role
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
High School diploma or GED equivalent
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.