Job Title: Claims Processing - Representative I (AZ Residents Only)

Job Description:
The Claims Processing Representative I will be responsible for reviewing and processing insurance claims for accuracy and compliance with company policies. This role, available only to Arizona residents, involves handling a variety of claims, ensuring they are processed in a timely and efficient manner. The ideal candidate will have attention to detail, strong organizational skills, and a basic understanding of insurance claims processing.

Key Responsibilities:

• Review and process incoming claims, verifying that all necessary documentation and information are included.
• Ensure claims are processed in compliance with company policies and procedures.
• Communicate with policyholders, providers, and other departments to resolve any issues related to claims.
• Research and investigate claims that require further review or clarification.
• Enter claim information into the system accurately and promptly.
• Work with supervisors to resolve escalated or complex claims issues.
• Maintain accurate records of claims and follow-up actions.

Requirements:

• High school diploma or equivalent (some college coursework is a plus).
• Previous experience in claims processing or customer service is preferred, but not required.
• Strong attention to detail and ability to handle large volumes of information.
• Excellent organizational and communication skills.
• Ability to work independently and in a team environment.
• Proficiency in Microsoft Office and basic computer skills.
• AZ residency required.

Benefits:

• Competitive salary and performance-based incentives.
• Comprehensive health benefits (medical, dental, and vision).
• 401(k) plan with employer matching.
• Paid time off (PTO) and holiday pay.
• Employee wellness programs.
• Opportunity for growth and advancement within the company.

Company Overview:
We are a well-established leader in the insurance industry, dedicated to providing exceptional service to our clients and customers. Our team is committed to delivering accuracy and efficiency in claims processing, ensuring that claims are handled with care and professionalism. We strive to maintain a supportive and collaborative work environment for all employees.

Equal Opportunity Employer Statement:
We are an Equal Opportunity Employer and welcome applicants from all backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability, or veteran status.

If you're a detail-oriented individual looking to start your career in claims processing, apply today to become a Claims Processing Representative I!

Job description

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. Position Summary This position requires an onsite working arrangement in Arizona. Our Claims team is looking for experienced Claims Processors to join our fast-paced Claims Department. As a Claims Processor, you will be responsible for accurate and efficient adjudication of paper claims from electronic images in a production environment. Primary Responsibilities of the Claims Processor include: -Outbound calls to Members and/or Providers for verification of information -Processing and adjudicating paper claims. -Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures. -Accurately resolving pending claims using state and federal regulations and specific health plan criteria. -Working within turnaround times to meet client performance guarantees for claims processing. -Meeting productivity and accuracy standards Required Qualifications -At least 1 year of work experience that shows a progressive trend in responsibility and accountability preferably in a Healthcare setting -Excellent verbal and written communication skills -In-depth experience working with Microsoft Office Suite products Preferred Qualifications - Call center type experience - Previous PBM Experience - Strong typing skills with speed and accuracy - Team-oriented while also able to pursue personal and departmental production goals daily - Ability to stay organized in a multi-demand and multi-priority environment - Ability to work overtime as necessary Education Verifiable High School Diploma or GED required Pay Range The typical pay range for this role is: $17.00 - $28.46 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 Benefits | CVS Health We anticipate the application window for this opening will close on: 01/20/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.