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CVS Health Logo CVS Health · Customer Service

Claim Benefit Specialist Operations

United States, Franklin Employment contract 17.00 - 28.46 USD / Hour · Job Posted May 29, 2026
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Job Description

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 ourselves accountable 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.

Job Responsibility

  • Handles and processes Benefits claims submitted by healthcare providers, 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
  • Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements
  • Documents claim information in the company system, assigning appropriate codes, modifiers, and other 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 healthcare providers, patients, 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

Requirements

  • Less than one (1) year of relevant experience in healthcare, insurance, claims processing, billing, coding, customer service, or administrative support
  • Ability to read, interpret, and apply policies, procedures, and benefit plan information
  • Strong attention to detail and accuracy when reviewing data, documentation, and codes
  • Basic proficiency with computer systems and data entry, including the ability to learn claims processing systems and software
  • Effective written and verbal communication skills, with the ability to communicate professionally with healthcare providers, policyholders, and internal teams
  • Ability to manage multiple tasks, meet deadlines, and work effectively in a fast-paced, production-oriented environment
  • Ability to work independently and collaboratively as part of a team
  • High school diploma or equivalent required

Nice to have

  • Familiarity with medical billing, claims processing, or healthcare terminology
  • Experience working with highly confidential or regulated information
  • Prior experience in a healthcare, insurance, or customer service environment
  • Comfortable working in a hybrid work environment
  • Some experience in a highly regulated, fast pace environment

What we offer

  • Medical, dental, and vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources
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