Claim Benefit Specialist, CVS Health

Claim Benefit Specialist

CVS Health

Location:
United States, Work at Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 28.46 USD / Hour

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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 stakeholders to resolve discrepancies
Ensures compliance with regulatory requirements
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
Must live in and work the Eastern or Central Time Zone
Experience in a production environment
Claims processing experience in any field

Nice to have:

Medicaid
QNXT
Medical Coding
Microsoft Outlook/Excel

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
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:
November 04, 2025

Expiration:
November 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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