Healthcare Claims Benefit Specialist

CVS Health; Tennessee; On-site; USD 23,000 - 35,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings plan

Wellness programs

Job summary

CVS Health is seeking a Claim Benefit Specialist in the United States to support claims processing and verification. The role includes training over 20 weeks virtually, 40 hours per week, with a flexible schedule after ramp-up.

You will apply medical necessity guidelines and verify eligibility while ensuring accurate coding and timely adjudication of claims. The ideal candidate has 1–2 years in customer service, strong teamwork and communication skills, and the ability to manage multiple tasks

Qualifications

• 1-2 years of customer service experience.
• Strong teamwork and organizational skills.
• Excellent communication skills.
• Ability to manage multiple tasks with good time management.

Responsibilities

• Process benefits claims accurately and efficiently in accordance with policies.
• Determine eligibility and coverage based on patient plan and guidelines.
• Assess claims for coding accuracy, medical necessity, and documentation requirements.
• Document claim information in the system with codes and data elements for tracking.
• Communicate with healthcare providers and patients to resolve discrepancies.
• Ensure compliance with regulatory requirements and company policies.
• Analyze claims data and generate reports to identify trends and improvement areas.
• Support regular feedback and performance reviews to drive service quality.

Skills

Customer service

Teamwork

Communication

Time management

Education

High School diploma

Job description

CVS Health is seeking a Claim Benefit Specialist in the United States to support claims processing and verification. The role includes training over 20 weeks virtually, 40 hours per week, with a flexible schedule after ramp-up.

You will apply medical necessity guidelines and verify eligibility while ensuring accurate coding and timely adjudication of claims. The ideal candidate has 1–2 years in customer service, strong teamwork and communication skills, and the ability to manage multiple tasks