Remote Claim Benefit Specialist—Health Claims

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

Job summary

CVS Health is seeking a Claim Benefit Specialist for Commercial Operations in a remote/hybrid role based in Tennessee. You will review and adjudicate benefits claims, verify eligibility, determine coverage, and apply medical necessity guidelines while ensuring accurate documentation and timely processing.

The role involves communicating with healthcare providers and policyholders, supporting process improvements, and maintaining compliant claims practices.

Qualifications

• High School diploma or GED or equivalent.
• 1-2 years of customer service experience preferred.

Responsibilities

• Handle and process benefits claims submitted by healthcare providers.
• Determine eligibility and coverage based on patient plans.
• Review claims for medical necessity and coding accuracy.
• Document claim data in the system and communicate with providers and patients.

Education

High School diploma or GED

Job description

CVS Health is seeking a Claim Benefit Specialist for Commercial Operations in a remote/hybrid role based in Tennessee. You will review and adjudicate benefits claims, verify eligibility, determine coverage, and apply medical necessity guidelines while ensuring accurate documentation and timely processing.

The role involves communicating with healthcare providers and policyholders, supporting process improvements, and maintaining compliant claims practices.