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Claim Benefit Specialist Operations

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States

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Category:
Customer Service

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Contract Type:
Not provided

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Salary:

Not provided

Job Description:

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

Job Responsibility:

  • Performs claim documentation review
  • verifies policy coverage
  • assesses claim validity
  • communicates with healthcare providers and policyholders
  • ensures accurate and timely claims processing
  • Handles and processes Benefits claims submitted by healthcare providers
  • Determines eligibility and coverage of benefits for each claim
  • Assesses claims for accuracy and compliance with coding guidelines
  • Documents claim information in company system
  • Conducts reviews and investigations of claims
  • Communicates with healthcare providers and patients to resolve discrepancies
  • Ensures compliance with regulatory requirements
  • Develops and implements feedback and performance review processes
  • Analyzes claims data and generate reports

Requirements:

  • Less than 1 year work experience
  • Working knowledge of problem solving and decision making skills
  • High school diploma or equivalent required

Nice to have:

  • 1-2 years healthcare claims processing experience preferred
  • claims processing experience
What we offer:
  • Affordable medical plan options
  • 401(k) plan with matching company contributions
  • employee stock purchase plan
  • No-cost wellness screenings
  • tobacco cessation and weight management programs
  • confidential counseling
  • financial coaching
  • Paid time off
  • flexible work schedules
  • family leave
  • dependent care resources
  • colleague assistance programs
  • tuition assistance
  • retiree medical access

Additional Information:

Job Posted:
October 02, 2025

Expiration:
October 27, 2025

Employment Type:
Fulltime
Work Type:
Hybrid work
Job Link Share:
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