Claim Benefit Specialist, CVS Health

CVS Health

Location:
United States, Plantation, FL

Category:
Customer Service

Contract Type:
Not provided

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines
Acts as a subject matter expert by providing members and providers with high quality claim adjudication
May handle customer service inquiries and problems
Applies medical necessity guidelines, identifies discrepancies, and applies all cost containment
Measures to assist in the claim adjudication process
Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures
Identifies and reports possible claim overpayments, underpayments and any other irregularities
Performs claim rework calculations
Ensures accurate and timely claims processing

Requirements:

Proficient in basic computer operations and software applications
Experience working in a production-driven environment
Demonstrated ability to handle multiple assignments efficiently, accurately and efficiently
Strong oral and written communication abilities

Nice to have:

Familiarity with medical terminology
Hands on experience in end-to-end medical claims processing
Knowledge of the ACAS system

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Additional Information:

Job Posted:
August 13, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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Claim Benefit Specialist