Claim Benefit Specialist

CVS Health; United States; Sur place; USD 23 000 - 43 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Résumé du poste

CVS Health is seeking a highly motivated candidate to review and rework sensitive medical and hospital claims for our rework project department. They will work closely with the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims.

The role requires strong attention to detail, analytical skills, and proficiency in Excel. You will help ensure accuracy and timely resolutions across complex cases, including plan sponsor issues and regulatory

Qualifications

• Minimum 1 year of experience in medical claims processing or related healthcare role.
• Strong analytical and problem-solving skills for complex claim issues.
• Ability to manage multiple priorities with quality and turnaround time in mind.
• Attention to detail and accuracy, with Excel proficiency.

Responsabilités

• Review and rework sensitive medical and hospital claims for rework projects.
• Provide root cause analysis and precise resolution of affected claims.
• Interface with appropriate areas to ensure claims are resolved by due date.
• Support compliance and handle complex issues for provider networks.

Connaissances

Medical claims processing

Research & problem solving

Excel basics

Multitasking

Attention to detail

Formation

High School diploma or equivalent

Description du poste

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

CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. They will work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims. The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date. The candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns.

Required Qualifications

• Minimum 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a related healthcare administrative role.
• Strong analytical and problem-solving skills with the ability to research and resolve complex claim issues.
• Proven ability to manage multiple priorities while meeting quality and turnaround time expectations.
• Strong attention to detail and commitment to accuracy.
• Proficiency in Microsoft Excel, including sorting, filtering, and basic data analysis.
• Demonstrated ability to work effectively in a fast-paced environment while adapting to changing business needs.

Preferred Qualifications

• Experience working in healthcare, insurance, claims processing, medical billing, or customer service.
• Knowledge of medical terminology, insurance benefits, or healthcare operations.
• Experience using computer systems to research and resolve customer or claim-related issues.
• Ability to work independently and collaboratively in a team environment.
• Strong organizational and time management skills.
• Demonstrated adaptability and willingness to learn new processes and systems

Education

High School diploma or equivalent

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $17.00 - $31.30

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: 11/14/2026

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

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.