Claims Benefit Specialist- Life Claims- Hybrid TN at CVS Health

Franklin, Tennessee, United States

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Must report into Franklin, TN office Tuesday-Thursday
Experience in a high production environment
Experience with Microsoft Office (specifically Excel)
Ability to review and triage documents to the correct location
Ability to multi-task, prioritize, & handle multiple workloads/assignments
Ability to collaborate with team members to resolve any issues
HS Diploma

Responsibilities

Handles and processes final expense claims submitted by beneficiaries, ensuring accuracy, efficiency, and strict adherence to policies and guidelines
Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope
Documents claim information in the company system, assigning necessary data elements to ensure accurate tracking, reporting, and processing of claims
Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution
Communicates with funeral homes, beneficiaries, family members, or other stakeholders to resolve any discrepancies or issues related to claims
Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies
Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development
Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department
Conducts outbound calls on an as needed basis to respective parties
Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with funeral homes, beneficiaries and family members, and ensures accurate and timely claims processing

Skills

Claims Processing

Policy Verification

Claim Validation

Claim Documentation

Stakeholder Communication

Claim Investigation

Regulatory Compliance

Life Insurance

Final Expense Claims

Customer Service

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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