Claim Benefit Specialist, CVS Health

CVS Health

Location:
United States, Work At Home

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 routine claims in accordance with claim processing guidelines
Analyzes and approves routine claims that cannot be auto adjudicated
Applies medical necessity guidelines, determines coverage, complete eligibly verification, identify discrepancies and applies all cost containment measures to assist in the claim adjudication process
Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues
Routes and triages complex claims to Senior Claim Benefits Specialist
Proofs claim or referral submission to determine, review or apply appropriate guidelines, coding, member identification process, diagnosis and pre-coding requirements
May facilitate training when considered topic subject matter expert
In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters
Utilizes all applicable system functions available ensuring accurate and timely claim processing services

Requirements:

Experience in a production environment
Claims processing experience in any field

Nice to have:

Medicaid
QNXT
Medical Coding

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
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 08, 2025

Expiration:
August 12, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Claim Benefit Specialist