Benefits Claims Specialist: Fast, Accurate Payments

4062 Aetna Resources, LLC; Franklin (VA); On-site; USD 35,000 - 59,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement options

Job summary

CVS Health is seeking a claims processor to support fast, accurate payments and member interactions. You will analyze routine claims not auto-adjudicated, apply coverage guidelines, verify eligibility, and route complex items to senior staff for resolution.

You will maintain accuracy, respond to inquiries, and provide guidance to teammates as needed, ensuring adherence to service-level targets and quality standards.

Qualifications

• 1+ years of experience in a production environment.
• Proficiency with Microsoft Office applications (Outlook, Word, Excel) and ability to learn new software.
• Ability to handle multiple assignments competently, accurately, and efficiently.

Responsibilities

• Analyze and process routine claims that cannot be auto-adjudicated.
• Apply medical necessity and coverage guidelines to support accurate claim decisions.
• Verify member eligibility and identify discrepancies affecting claim processing.
• Route complex claims and issues to senior team members for resolution.
• Maintain accuracy and productivity standards while meeting service-level expectations.

Skills

Production experience

MS Office

Multitasking

Analytical thinking

Education

High School or GED

Tools

Claim Check

Claims processing software

Job description

CVS Health is seeking a claims processor to support fast, accurate payments and member interactions. You will analyze routine claims not auto-adjudicated, apply coverage guidelines, verify eligibility, and route complex items to senior staff for resolution.

You will maintain accuracy, respond to inquiries, and provide guidance to teammates as needed, ensuring adherence to service-level targets and quality standards.