Homer, AK · Remote
$18.50 - $42.35/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... adjudication authority or processing expertise. - Applies medical necessity guidelines, determines ...
Homer, AK · Remote
$18.50 - $42.35/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... adjudication authority or processing expertise. - Applies medical necessity guidelines, determines ...
New York, NY · Remote
$18.50 - $42.35/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... adjudication authority or processing expertise. - Applies medical necessity guidelines, determines ...
New York, NY · Remote
$18.50 - $42.35/hr
At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... adjudication authority or processing expertise. - Applies medical necessity guidelines, determines ...
Associate's degree with relevant personnel security experience will also be considered ... Adjudication Support, Federal Adjudications, Personnel Security Adjudication, Federal Hiring ...
Associate's degree with relevant personnel security experience will also be considered ... Adjudication Support, Federal Adjudications, Personnel Security Adjudication, Federal Hiring ...
Saint Louis, MO · On-site
$50K - $54K/yr
... DISS, CVS). * Monitor shared communication channels (e.g., phone lines, inboxes) and route ... Associate's degree with at least 1+ year of experience supporting personnel security adjudication ...
Saint Louis, MO · On-site
$50K - $54K/yr
... DISS, CVS). * Monitor shared communication channels (e.g., phone lines, inboxes) and route ... Associate's degree with at least 1+ year of experience supporting personnel security adjudication ...
Saint Louis, MO · On-site
$36K - $38K/yr
... and adjudication, and processing of personnel separations. Chickasaw Nation Industries, Inc ... Experience training in Personnel Security Systems, (e.g., eQIP, DISS, CVS, or comparable). KEY ...
Saint Louis, MO · On-site
$36K - $38K/yr
... and adjudication, and processing of personnel separations. Chickasaw Nation Industries, Inc ... Experience training in Personnel Security Systems, (e.g., eQIP, DISS, CVS, or comparable). KEY ...
$36K - $38K/yr
... and adjudication, and processing of personnel separations. Chickasaw Nation Industries, Inc ... Experience training in Personnel Security Systems, (e.g., eQIP, DISS, CVS, or comparable). KEY ...
$36K - $38K/yr
... and adjudication, and processing of personnel separations. Chickasaw Nation Industries, Inc ... Experience training in Personnel Security Systems, (e.g., eQIP, DISS, CVS, or comparable). KEY ...
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Reston, VA · On-site
$72K - $87K/yr
... CVS; initiating and scoping * Determining security case completion and preparation for adjudication ... Associate's Degree in Security Management, Personnel Security, or Business * A combination of ...
Have knowledge of Trusted Associate Sponsorship System (TASS), NP2 Secure Portal: (e-QIP Electronic ... CVS Central Verification System), Defense Information System for Security (DISS), Case Adjudication ...
Have knowledge of Trusted Associate Sponsorship System (TASS), NP2 Secure Portal: (e-QIP Electronic ... CVS Central Verification System), Defense Information System for Security (DISS), Case Adjudication ...
Burleson, TX · Remote
$21.63 - $30.15/hr
CVS, Walgreens, Optum, etc) (Required) * Proficiency in insurance claim adjudication, including ... We empower our 97,000+ associates to bring their skills and expertise every day to reimagining ...
Burleson, TX · Remote
$21.63 - $30.15/hr
CVS, Walgreens, Optum, etc) (Required) * Proficiency in insurance claim adjudication, including ... We empower our 97,000+ associates to bring their skills and expertise every day to reimagining ...
Burleson, TX · Remote
$21.63/hr
CVS, Walgreens, Optum, etc) (Required) * Proficiency in insurance claim adjudication, including ... associates and applicants for employment without regard to race, color, religion, sex/gender ...
Burleson, TX · Remote
$21.63/hr
CVS, Walgreens, Optum, etc) (Required) * Proficiency in insurance claim adjudication, including ... associates and applicants for employment without regard to race, color, religion, sex/gender ...
Dallas, TX · On-site
$19 - $22/hr
Position Overview The position of Research & Resolution Associate (RRA) is responsible for the full ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
Dallas, TX · On-site
$19 - $22/hr
Position Overview The position of Research & Resolution Associate (RRA) is responsible for the full ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
Responsibilities & Qualifications Position Overview The position of Research & Resolution Associate ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
Responsibilities & Qualifications Position Overview The position of Research & Resolution Associate ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
$19 - $22/hr
Position Overview The position of Research & Resolution Associate (RRA) is responsible for the full ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
$19 - $22/hr
Position Overview The position of Research & Resolution Associate (RRA) is responsible for the full ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
Green Bay, WI · On-site
$25 - $29.09/hr
Testifies at adjudication hearings as necessary. Must have 1 year or more telecommunicator ... CVS Caremark administers the prescription drug benefits portion. We have a tiered system for ...
Green Bay, WI · On-site
$25 - $29.09/hr
Testifies at adjudication hearings as necessary. Must have 1 year or more telecommunicator ... CVS Caremark administers the prescription drug benefits portion. We have a tiered system for ...
$19 - $22/hr
Position Overview The position of Research & Resolution Associate (RRA) is responsible for the full ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
$19 - $22/hr
Position Overview The position of Research & Resolution Associate (RRA) is responsible for the full ... through adjudication and resolution. • Document all efforts to resolve balances utilizing ...
$10.82 - $12.85
7% of jobs
$14.85 is the 25th percentile. Wages below this are outliers.
$12.85 - $14.88
18% of jobs
$14.88 - $16.91
18% of jobs
The median wage is $17.42 / hr.
$16.91 - $18.95
27% of jobs
$19.81 is the 75th percentile. Wages above this are outliers.
$18.95 - $20.98
11% of jobs
$20.98 - $23.01
3% of jobs
$23.01 - $25.04
2% of jobs
$25.04 - $27.08
2% of jobs
$27.08 - $29.11
5% of jobs
$29.11 - $31.14
3% of jobs
$31.14 - $33.17
3% of jobs
$10
$19
$33
$18.50 - $42.35/hr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 23 days ago
5.8
Based on 4,278 frontline employees who took The Breakroom Quiz
80th of 104 rated pharmacies
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 ourselvesaccountable 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
Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience.
Additional Responsibilities
- Reviews prespecified claims and those that exceed specialist adjudication authority or processing expertise.
- Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements costcontainment measures to support accurate claim adjudication.
- Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures.
- Identifies and reports potential overpayments, underpayments, and other claim irregularities.
- Performs claim rework calculations as needed.
- Trains and mentors as needed to enhance team performance and technical proficiency.
- Conducts outbound calls to obtain required information for claims or reconsideration requests.
Required Qualifications
- Minimum of 18 months of medical claim processing experience with a health insurance payor or thirdparty administrator.
- Proven success working in a highvolume, productiondriven environment.
- Demonstrated ability to manage multiple assignments with accuracy, efficiency, and attention to detail.
Preferred Qualifications
- Self-Funding experience
- DG system knowledge
Education
- High School Diploma required
- Preferred Associates degree or equivalent work experience.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $42.35This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
