Customer Service – CVS Remote Jobs

Job Type: Customer Service from home
Location: Florida work from home
Company: CVS Health

Examines and decides on insurance claims for private family plans.

By offering precise and prompt resolution when processing medical claims, claim benefit specialists have the chance to increase and improve member satisfaction and retention. You will play a crucial role in delivering timely, effective, and high-quality claim assistance to our clients.

• Discover and comprehend the coverage offered by a member’s health plan.
• Utilize various systems and displays effectively to gather and record claim information
• Determine the type of a member’s illness or injury by reviewing the claims data. Look for opportunities to reduce claim costs.
• decide on claim payment
• To increase customer satisfaction and retention, handle claims appropriately.
• Process claims that adhere to production and quality requirements
• Encourage team members to work together to achieve the team’s, office’s, regional, and overall goals.

Pay Scale

The standard pay scale for this position is as follows: Minimum: 17.00 Maximum: 27.90

Please remember that this range represents the salary range for every position in the job grade that this position belongs to. The location is just one of several variables that will be considered when determining the actual compensation offer.

required credentials

Required credentials:

• Attendance is needed during the 20-week training period.Eexperience working in a production-oriented setting.
• A focus on the details.
• The capacity to simultaneously use many computer applications.
• Processing of claims knowledge.
• Regular claims that cannot be automatically decided upon are examined and approved.
• To aid in the claim adjudication process, medical necessity rules are used, coverage is determined, eligibility is verified, discrepancies are found, and all cost-containment measures are applied.
• Sends difficult claims to the senior claim benefits specialist and triages them.
• Proofs the submission of a claim or referral in order to choose, review, or apply the proper rules, pre-coding requirements, member identification processes, provider selection processes, and claim coding, including procedure, diagnosis, and claim coding.
• When a subject matter expert, may facilitate training.
• makes use of all relevant system features to guarantee prompt and accurate claim processing.

Preferred Requirements

• Strong communication skills in both writing and speaking.
• Being able to uphold accuracy and production standards.
• Technical expertise.
• Precision and attention to detail.
• Abilities in analysis.
• The capacity to multitask

Education: GED or high school diploma required