Bring your expertise in medical claims to a leading health solutions company. CVS Health is hiring Senior Claim Benefit Specialists to adjudicate complex claims, mentor peers, and ensure compliance with medical necessity and coverage guidelines.
About CVS Health
CVS Health is the nation’s leading health solutions company, serving millions of Americans through local presence, digital channels, and more than 300,000 colleagues. We are passionate about transforming healthcare to make it more connected, convenient, and compassionate.
Schedule
- Full-time, 40 hours per week
- Remote role, available in up to 50 locations
- Specific schedules vary by assignment
Responsibilities
- Review and adjudicate complex or sensitive claims per plan guidelines.
- Apply medical necessity criteria, verify eligibility, and ensure cost-containment measures.
- Handle phone and written inquiries regarding pre-approvals, reconsiderations, or appeals.
- Identify discrepancies, calculate claim reworks, and report irregularities.
- Mentor and train claim benefit specialists; distribute daily work assignments.
- Make outbound calls to obtain claim or reconsideration details.
- Ensure compliance with regulations and company policies.
Requirements
- High school diploma required (Associate’s degree preferred).
- New York Independent Adjuster License.
- Experience working in a production environment with multiple priorities.
- 18+ months of medical claim processing preferred.
- Knowledge of self-funding and DG systems is a plus.
- Strong organizational, analytical, and problem-solving skills.
Compensation
- Pay range: $18.50 – $42.35/hour
- Eligible for CVS Health bonus, commission, or short-term incentive program
Benefits
- Affordable medical, dental, and vision plans
- 401(k) with company match & employee stock purchase program
- Paid time off, flexible schedules, and family leave
- No-cost wellness programs: screenings, counseling, tobacco cessation, weight management
- Tuition assistance and retiree medical access (based on eligibility)
Join a purpose-driven team dedicated to making healthcare better for everyone.
Happy Hunting,
~Two Chicks…