Bring your expertise to one of the nation’s leading healthcare companies. CVS Health is hiring Senior Claim Benefit Specialists to review, adjudicate, and resolve complex medical claims while ensuring compliance and accuracy. This role is ideal for detail-oriented professionals who thrive in fast-paced environments and want to make an impact in the healthcare system.
About CVS Health
CVS Health is reimagining healthcare with over 300,000 colleagues serving millions of Americans every day. Through digital channels, local care delivery, and integrated health solutions, CVS Health helps people access affordable, convenient, and compassionate care.
Schedule & Compensation
- Full-time, remote position
- Anticipated 40 hours per week
- Pay range: $18.50 – $42.35 per hour (plus bonus or short-term incentives depending on eligibility)
What You’ll Do
- Review and adjudicate complex or specialized claims according to plan guidelines
- Apply medical necessity standards, verify eligibility, and ensure compliance with cost-containment procedures
- Handle pre-approval, pre-authorization, reconsiderations, and appeals via phone or written inquiries
- Identify and report possible claim irregularities, including overpayments or underpayments
- Perform claim rework calculations and distribute work assignments to junior staff
- Mentor and train Claim Benefit Specialists while serving as a subject matter expert
- Make outbound calls to gather required information for claims or reconsiderations
What You Need
- High school diploma required; associate degree preferred
- New York Independent Adjuster License required
- Previous experience in a production environment
- Strong ability to handle multiple tasks accurately and efficiently
- Preferred: 18+ months of medical claim processing, self-funding experience, and DG system knowledge
Benefits
- Comprehensive medical, dental, and vision coverage
- 401(k) plan with company match + employee stock purchase plan
- Paid time off, flexible schedules, family leave, and dependent care resources
- Tuition assistance and career growth opportunities
- Wellness programs including confidential counseling, weight management, and smoking cessation support
Join CVS Health and help transform healthcare for millions of Americans. This application window is expected to close on October 1, 2025—apply today to be considered.
Happy Hunting,
~Two Chicks…