Senior Claim Data Specialist, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Not provided

Salary:

18.50 - 31.72 USD / Hour

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Job Description:

Claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquires to determine if there are any claim payment or denial issues that may affect Utilization Management, Enrollment, Claims, Configuration, Network, Contracting and/or Provider Data.

Job Responsibility:

Claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquires
Determine if there are any claim payment or denial issues affecting Utilization Management, Enrollment, Claims, Configuration, Network, Contracting and/or Provider Data
Submit necessary documents to specific areas to ensure updates and corrections
Submit projects and/or claims to be reprocessed
Provider, internal and external education when required
Attending provider group meetings as well as individual meetings internally and/or externally
Submitting projects within Excel

Requirements:

Must reside in Florida
2-3 years of provider claims experience
2-3 years of intermediate Excel experience with proficiency in formulas
High School Diploma or GED

Nice to have:

Certified Professional Coder (CPC)
Provider Billing Knowledge with Professional and Hospital claims
Bilingual in Spanish

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
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 21, 2025

Expiration:
September 02, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Claim Data Specialist