Claims Processing - Representative I

📋 Description

• • Join CVS Health Corporation, a leader in shaping a world of health, and contribute to a more connected, convenient, and compassionate healthcare experience.
• • As a Claims Processing Representative I, you will play a crucial role within our Direct Member Reimbursement (DMR) Claims team, a fast-paced and dynamic environment.
• • Your primary responsibility will be the accurate and efficient adjudication of paper claims, processed from electronic images, within a high-volume production setting.
• • This role demands meticulous attention to detail to ensure the integrity and accuracy of each claim processed, directly impacting member satisfaction and operational efficiency.
• • You will be tasked with reviewing claim forms, verifying member eligibility, checking for completeness of information, and applying appropriate adjudication rules and guidelines.
• • A key aspect of this position involves understanding and navigating various healthcare regulations and company policies to ensure compliance in all claim processing activities.
• • You will work with electronic images of claims, requiring a keen eye to identify any discrepancies or missing information that could hinder the processing.
• • The ability to interpret and apply complex processing guidelines and policies is essential for success in this role.
• • You will be expected to meet daily production goals, demonstrating a strong commitment to efficiency and productivity while maintaining high standards of quality.
• • This position offers a remote work opportunity, providing flexibility and the ability to work from home.
• • However, it is important to note that your work schedule will be aligned with the Arizona (AZ) time zone, ensuring seamless collaboration with the team.
• • You will be an integral part of a team that is dedicated to simplifying healthcare, one person, one family, and one community at a time.
• • The role requires strong organizational skills to manage multiple demands and priorities effectively in a constantly evolving workflow.
• • You will utilize your excellent verbal and written communication skills to interact with team members and potentially escalate complex issues.
• • Proficiency in Microsoft Office Suite is a fundamental requirement, enabling you to manage documentation, communication, and data effectively.
• • This is a full-time position, offering a stable and consistent work schedule.
• • The work involves a significant amount of data entry and review, requiring speed and accuracy in your typing.
• • You will be encouraged to be team-oriented, contributing to a collaborative work environment, while also being driven to achieve your individual production targets.
• • The ability to manage your time effectively is paramount to meeting the daily production goals set for this role.
• • By joining CVS Health, you become part of a company that is committed to fostering a workplace where every colleague feels valued and that they belong.
• • You will contribute to a culture that prioritizes safety and quality in all aspects of its operations.
• • This role is an excellent opportunity for individuals seeking to build a career in the healthcare industry, specifically within claims processing and administration.
• • You will gain valuable experience in healthcare reimbursement, PBM operations (if applicable), and the intricacies of the healthcare system.
• • The company's mission to build a world of health around every individual aligns with a purpose-driven career path.
• • You will be part of a supportive team environment that encourages professional growth and development.
• • The remote nature of the role allows for a better work-life balance, provided you can adhere to the AZ time zone schedule.
• • Your contributions will directly support the company's overarching goal of making healthcare more accessible and manageable for millions of people.
• • This position requires a high degree of self-discipline and motivation to succeed in a remote work setting.
• • You will be expected to maintain a professional demeanor and work ethic at all times.
• • The role is designed for individuals who are detail-oriented, process-driven, and committed to delivering accurate results.
• • Embrace the opportunity to be part of a company that is actively working to improve the health and well-being of its customers and communities.