Want to bring your claims expertise to a team that’s transforming healthcare? CVS Health is hiring Senior Claim Benefit Specialists to review, adjudicate, and resolve complex claims—helping ensure accuracy, compliance, and exceptional service for members and providers.
About CVS Health
As the nation’s leading health solutions company, CVS Health serves millions of Americans through local presence, digital channels, and more than 300,000 purpose-driven colleagues. We’re reimagining healthcare to be more connected, convenient, and compassionate—building a world of health around every consumer.
Schedule
- Full-time, 40 hours per week
- Remote role, available across 50 U.S. locations
- Occasional training, coaching, or mentoring responsibilities
What You’ll Do
- Review and adjudicate sensitive, complex, or specialized claims following plan processing guidelines
- Apply medical necessity guidelines, verify coverage and eligibility, and use cost-containment measures
- Investigate discrepancies, overpayments, underpayments, and irregularities
- Handle inquiries related to pre-approvals, reconsiderations, and appeals
- Make outbound calls to gather claim information when needed
- Train, mentor, and assign work to junior staff members
- Ensure all compliance and payment requirements are met
What You Need
- Minimum 18 months of medical claim processing experience
- Strong background in a production environment
- Ability to manage multiple assignments accurately and efficiently
Preferred Qualifications
- Self-funding experience
- Familiarity with DG system
Education
- High School Diploma required
- Associate degree or equivalent work experience preferred
Benefits
- Pay range: $18.50 – $42.35/hour (eligible for bonuses or incentives)
- Comprehensive medical, dental, and vision coverage
- 401(k) with company match & employee stock purchase plan
- Paid time off, flexible scheduling, and family leave options
- Tuition assistance and career development support
- Wellness programs, confidential counseling, and financial coaching
Bring your claims expertise to CVS Health and help improve healthcare experiences nationwide.
Take the next step in your claims career today.
Happy Hunting,
~Two Chicks…