This is a full time telework position. Qualified candidates may reside in any state (US).

Shift times: 6:00 AM – 4:30 Mountain Standard Time.

The Senior Claim Benefit Specialist (OPS) reviews and corrects Encounters through the Edifecs system and may adjudicate complex, sensitive, and/or specialized claims in accordance with claim processing guidelines through the claims QNXT system.

Fundamental Components:

• Works to research and resolve encounter errors

• Ensures all compliance requirements are met.

• Identifies and reports possible claim overpayments, underpayments, scanning issues and any other irregularities.

Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60

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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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

jobs.CVSHealth.com/benefits

Required Qualifications

• 2 years Medical Claims processing experience (Commercial, Medicaid, Medicare, etc.)
• Experience in a production environment.
• Analytical skills, with the ability to research particularly in areas involving rejected claims.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Demonstrated proficiency with personal computer, keyboard navigation skills, and MS Office Suite applications.

Preferred Qualifications

• QNXT claims processing experience is highly desired.
• Understanding of medical terminology.
• Strong knowledge of benefit plans, policies, and procedures.
• Oral and written communication skills.
• Ability to maintain accuracy and production standards.
• Technical skills

Education
High School Diploma or equivalent GED

Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. 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.