Reinsurance/Stoploss Medical Claims Adjustor

Clinical Careers Page(13 days ago)

FloridaOnsiteFull TimeMedior$18,500 - $42,350Claims Processing

About this role

This role involves reviewing, researching, and adjusting complex Reinsurance/Stoploss medical claims. The focus is on ensuring accuracy in claim adjustments, compliance with guidelines, and effective communication with stakeholders. It requires collaboration across teams to manage complex claims and handle inquiries.

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Required Skills

claims Processing
Reinsurance
Stoploss
Medical Claims
Medical Necessity
Claims Reconciliation
Customer Service
Medical Contracts
Reinsurance Claims
Claims Adjustments

About Clinical Careers Page

cvshealth.com

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.

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