Claim specialist Jobs in Sunnyvale, CA

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Position Summary

CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. They will work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims. The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date.

The candidate will serve as a medical / hospital claim processor for rework projects, compliance, and complex issues for a specific provider / network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and / or legal / regulatory / compliance concerns.

Required Qualifications

• Must have 1 year of experience processing medical and hospital claims.
• Experience in a Medical claims / billing background
• Will be responsible for performing a detailed analysis and reworking complex claim issues.
• This candidate should demonstrate a strong work ethic.
• Being efficient and flexible is essential to the position in order to meet critical turnaround objectives.
• Proficient in Excel experience.

Preferred Qualifications

Education

Pay Range

The typical pay range for this role is :

17.00 - $29.88

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.