If you’re sharp with complex claims and you don’t flinch under pressure, this role puts you in the driver’s seat. You’ll adjudicate sensitive claims, support appeals, and serve as a go-to expert for the team.
About CVS Health
CVS Health is a leading health solutions company focused on building a more connected, convenient, and compassionate healthcare experience. They serve millions of people through local, digital, and clinical channels.
Schedule
- Full-time (40 hours/week)
- Remote
- Application window closes: 02/27/2026
What You’ll Do
- Review and adjudicate complex and specialized claims using plan processing guidelines
- Apply medical necessity guidelines, determine coverage, verify eligibility, and flag discrepancies
- Apply cost containment measures during claim adjudication
- Handle phone and written inquiries for pre-approvals, pre-authorizations, reconsiderations, and appeals
- Ensure compliance requirements are met and payments follow company practices and procedures
- Identify and report potential overpayments, underpayments, and other claim irregularities
- Perform claim rework calculations
- Make outbound calls to obtain missing information needed for claims or reconsiderations
- Distribute daily work assignments to junior staff
- Train, coach, and mentor claim benefit specialists as a subject matter resource
What You Need
- High School Diploma (required)
- New York Independent Adjuster License (required)
- Experience working in a production environment
- Ability to manage multiple assignments accurately and efficiently
Benefits
- Competitive pay range: $18.50 – $42.35 (base pay; actual offer varies by experience, education, and geography)
- Eligible for CVS Health bonus, commission, or short-term incentive programs (role dependent)
- Medical plan options
- 401(k) with company match
- Employee stock purchase plan
- Wellness and health support programs (including screenings and coaching programs)
- Confidential counseling and financial coaching
- Paid time off, flexible scheduling options, and family leave (based on eligibility)
- Tuition assistance and additional resources (based on eligibility)
Hiring is moving, and this posting closes soon.
If you want a remote role where your judgment actually matters, this is a strong one.
Happy Hunting,
~Two Chicks…