Handle complex medical claims with accuracy, speed, and good judgment, while serving as the go-to resource when things get tricky. If you’ve got strong claim adjudication skills and can coach others while keeping production moving, this role fits.
About CVS Health
CVS Health is a leading health solutions company focused on making care more connected, convenient, and compassionate. With a national footprint and purpose-driven teams, CVS supports millions of members through healthcare services and benefits operations.
Schedule
- Full-time (40 hours/week)
- Remote
- Application window closes: 02/27/2026
What You’ll Do
- Review and adjudicate complex, sensitive, and specialized claims using plan processing guidelines
- Apply medical necessity guidelines, confirm coverage, verify eligibility, and identify discrepancies
- Use cost containment measures as part of the claim adjudication process
- Respond to phone and written inquiries related to pre-approvals, pre-authorizations, reconsiderations, and appeals
- Ensure compliance requirements are met and payments align with company practices and procedures
- Identify and report potential overpayments, underpayments, and other claim irregularities
- Perform claim rework calculations and assist with reprocessing when needed
- Distribute daily work assignments to junior staff
- Train, mentor, and support claim benefit specialists
- Make outbound calls to gather missing information for claims or reconsiderations
What You Need
- New York Independent Adjuster License
- Experience working in a production environment
- Proven ability to manage multiple assignments accurately and efficiently
- High School Diploma (Associate’s degree or equivalent experience preferred)
Benefits
- Pay range: $18.50–$42.35/hour (based on experience, education, geography, and other factors)
- Eligible for bonus/commission/short-term incentive programs (role-dependent)
- Medical plan options
- 401(k) with matching contributions and employee stock purchase plan
- No-cost wellness programs, counseling, and financial coaching
- Paid time off and flexible work schedules (eligibility-based)
- Family leave, dependent care resources, and tuition assistance (eligibility-based)
- Retiree medical access and additional benefits depending on eligibility
This one has a close date, so if you already hold that NY license, move on it.
You know the rules. You know the work. Now go get paid for being the steady hand.
Happy Hunting,
~Two Chicks…