Medical Claims Adjuster

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. The Medical Claims Adjuster will review and adjust claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. - Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. - Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. - Performs claim re-work calculations. - Follow through completion of claim overpayments, underpayments, and any other irregularities. - Process complex no...