If you’re detail-obsessed, calm under pressure, and you like solving “why didn’t this pay” puzzles all day, this is that lane. You’ll be the first set of eyes on claims, triaging issues fast so cases move cleanly through the system and hit regulatory turnaround times.
About CVS Health
CVS Health is building a more connected, convenient, and compassionate healthcare experience across retail, digital, and health solutions. You’ll be supporting the operational engine that keeps member care and claim decisions moving.
Schedule
- Full-time, 40 hours/week
- Remote
What You’ll Do
- Perform initial review and triage of claims assigned for review
- Determine coverage and verify eligibility
- Identify misdirected items and redirect them appropriately
- Prep authorizations in the system and route cases to medical staff for review
- Organize and prioritize work to meet regulatory and claim turnaround timelines
- Communicate clearly with internal partners (and externally when needed) to support effective medical management
- Perform non-medical research and support related to claim/payment issues
- Maintain accurate documentation that meets risk management, regulatory, and accreditation standards
- Protect member confidentiality and follow compliance and regulatory requirements
- Assist with research and resolution of claims payment issues
What You Need
- Strong communication skills (including on the phone) and strong organization habits
- Familiarity with basic medical terminology and care concepts
- Strong customer service skills, including sensitivity and proactive problem-solving
- Computer literacy and ability to navigate multiple systems, including Excel and Microsoft Word
- Education: High School Diploma or GED
Preferred
- 2–4 years experience as a medical assistant, office assistant, or claim processor
- Experience with MedCompass, CEC, or ACAS (nice to have)
Benefits
- Medical plan options
- 401(k) with matching company contributions
- Employee stock purchase plan
- Wellness programs, counseling, and financial coaching
- PTO and additional benefits depending on eligibility
Pay
- Typical range: $18.50 – $38.82/hour (final offer depends on experience, education, location, and other factors)
Deadline: Application window expected to close 12/27/2025.
This is a “be sharp, be fast, be accurate” role. If you like structured work with real consequences (and you do), it’s a solid target.
Happy Hunting,
~Two Chicks…