Help a nationwide health leader deliver accurate, compassionate claim decisions at scale. Use your adjudication expertise to resolve complex medical claims, mentor teammates, and elevate quality for millions of members.
About CVS Health
CVS Health is a leading health solutions company serving millions across local pharmacies, digital channels, and care delivery. With 300,000+ colleagues, the company focuses on connected, convenient, and compassionate care.
Schedule
- Full-time, remote role (U.S.)
- 40 hours per week
- May handle phone and written inquiries alongside claim work
What You’ll Do
- Review and adjudicate complex/sensitive claims per processing guidelines
- Apply medical necessity rules, verify eligibility, and ensure cost-containment and compliance
- Handle inquiries for pre-approvals, reconsiderations, and appeals
- Identify and report overpayments/underpayments; perform rework calculations
- Distribute assignments to junior staff; train and mentor specialists
- Make outbound calls to obtain missing information
What You Need
- New York Independent Adjuster License
- Experience in a production environment with strong multitasking and accuracy
- Preferred: 18+ months medical claim processing, self-funding experience, DG system knowledge
- Education: High School Diploma required; Associate’s or equivalent experience preferred
Benefits
- Pay range: $18.50–$42.35 per hour (base rate or salary equivalent; actual offer depends on experience, location, and other factors)
- Eligible for bonus/short-term incentives
- Comprehensive medical plan options, 401(k) with company match, employee stock purchase plan
- No-cost wellness programs, counseling, financial coaching
- PTO, flexible schedules, family leave, dependent care resources, tuition assistance (eligibility varies)
Applications are time-sensitive—submit yours before the window closes.
Make an impact where accuracy, empathy, and expertise matter.
Happy Hunting,
~Two Chicks…