Claim Benefit Specialist

CVS Health; Atlanta (GA); On-site; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is hiring for a full-time claims processor in the Atlanta area. You will review and adjudicate medical claims, applying clinical guidelines to determine coverage and verify eligibility while managing discrepancies and cost controls.

Responsibilities include processing claims efficiently, handling rework items, and using multiple systems to ensure accuracy and timeliness. Strong customer service, teamwork and communication are essential for success.

Qualifications

• High school diploma or GED required.
• 1–2 years in customer service.
• Strong teamwork, organizational and communication skills.
• Ability to manage multiple tasks with time discipline.

Responsibilities

• Review and adjudicate claims according to processing guidelines.
• Apply medical necessity guidelines and determine coverage.
• Verify eligibility, identify discrepancies and apply cost containment measures.
• Review and approve rework claims not auto adjudicated.
• Handle desk, queues and electronic correspondence within turn-around times.
• Utilize system tools to ensure accurate, timely processing.

Skills

Customer service

Teamwork

Communication

Time management

Education

High School Diploma

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

• Reviews and adjudicates claims in accordance with claim processing guidelines.
• Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
• Review claims or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis, and pre-coding requirements.
• Analyzes and approves rework claims that cannot be auto adjudicated.
• In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).
• Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., utilizes Claim Check, reasonable and customary data, and other post-containment tools).

Required Qualifications

• 1-2 years working in customer service.
• Possess strong teamwork and organizational skills.
• Strong and effective communication skills.
• Ability to handle multiple assignments competently through use of time management, accurately and efficiently.

Preferred Qualifications

• Experience in a production environment.
• Knowledge of utilizing multiple systems at once to resolve complex issues.
• Claim processing experience preferred but not required.
• Understanding of medical terminology.

Education

High School diploma, GED or equivalent Experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$17.00 - $25.65

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/29/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.