Senior Claim Data Specialist, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

18.50 - 31.72 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:

Handle phone and written inquiries from internal teams regarding claims adjudication outcomes, systems benefit configuration issues, appeals, and operations workflows
Ensure all compliance requirements are satisfied and that all payments are made against company practices and procedures
Identify, report, and prevent possible claim overpayments, underpayments, and any other irregularities
Perform claims re-work calculations
Review and submit requests for auto-adjudication
Review and resolve pended claims with provider and/or billing data mismatches
Occasionally make outbound calls, in collaboration with Provider Services, to offer provider education
Perform review of submitted claims and configuration projects and results
Report financial impact of completed tasks
Look at trends in data and perform subsequent analysis
Make recommendations as needed and address risks based on research and analysis
Perform other duties as assigned

Requirements:

2+ years of experience with medical claims and/or claims processing
At least 1 year of experience with medical coding
Expert knowledge in Microsoft Suite applications (Teams, Outlook, Word, Excel, etc.)
Must reside in Oklahoma

Nice to have:

Previous experience with QNXT, Remedy, and/or SQL
Knowledge of Oklahoma Medicaid Program
Previous experience in technical writing
Previous experience in creating workflows
Previous experience in working remotely
Demonstrated successful project completion, specifically within a team environment
Demonstrated analytical and strategic thinking
ability to output analysis into easily digestible summaries
Ability to prioritize tasks based on type and impact
Ability to pivot quickly with competing priorities
Demonstrated adaptability, with a keen ability to work in a matrixed and potentially high-stress environment
Cross-departmental communication skills
Demonstrated professionalism, in both verbal and written communications
Strong knowledge of benefit plans
Ability to work collaboratively
Ability to spot trends quickly and accurately
Ability to take initiative as needed
Demonstrated problem-solving skills
Previous experience with creating and analyzing reports

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 19, 2025

Expiration:
September 01, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Claim Data Specialist