Remote Benefits Claims Specialist

CVS Health Corporation; Northern (KY); Hybrid; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Job summary

CVS Health is seeking a remote Claim Benefits Specialist to review and adjudicate benefits claims. You will verify coverage, apply medical necessity guidelines, and document outcomes while communicating with providers and members.

The role emphasizes accuracy, regulatory adherence, and timely processing from a home-based setting. The position starts at $18.50 per hour with full-time hours and a comprehensive benefits package.

Qualifications

• Less than 1 year of work experience.
• Claims processing experience in any field.
• Preferred: Medicaid, QNXT, Medical Coding and Microsoft Outlook/Excel.

Responsibilities

• Handles and processes benefits claims submitted by healthcare providers.
• Determines eligibility and coverage based on policy guidelines.
• Documents claim information in the system with codes and data elements.
• Communicates with providers, patients, and stakeholders to resolve discrepancies.
• Reviews and adjudicates routine claims within guidelines and turn-around times.

Skills

Problem solving

Decision making

Communication

Education

High school diploma or GED

Tools

QNXT

Microsoft Outlook

Microsoft Excel

Job description

CVS Health is seeking a remote Claim Benefits Specialist to review and adjudicate benefits claims. You will verify coverage, apply medical necessity guidelines, and document outcomes while communicating with providers and members.

The role emphasizes accuracy, regulatory adherence, and timely processing from a home-based setting. The position starts at $18.50 per hour with full-time hours and a comprehensive benefits package.