Senior Claims Benefit Specialist - Checkwork/Refund

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: Review and complete provider-solicited and unsolicited overpayment refunds and returned checks. Research, resolve, and adjudicate complex, sensitive, and/or specialized medical claims in accordance with claims-processing guidelines. Partner with key business functions, ensure accurate posting of overpayment refunds, reconcile discrepancies, and respond to internal and provider inquiries. Key Responsibilities: Handle customer service inquiries and issues assigned - Process complex, non-routine provider refunds and returned checks - Review and interpret contract language to validate overpayments and allocate refund checks appropriately - Apply medical necessity guidelines, determine coverage, complete eligibility verification, iden...