Remote Claims Benefit Specialist

4062 Aetna Resources, LLC; Town of Florida (NY); Hybrid; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Claim Benefit Specialist to review and adjudicate benefits claims, verify eligibility, and apply cost-containment measures. You will document claim data, use medical coding rules, and communicate with providers and policyholders.

This 40-hour full-time role includes virtual training for 20 weeks, 8:00-4:30 EST, with a flex schedule after ramp-up. Anticipated weekly hours: 40, pay range: $17.00–$28.46 per hour, depending on experience and geography.

Qualifications

• 1-2 years of customer service experience required.
• Strong teamwork and organizational skills.
• Effective communication abilities.

Responsibilities

• Handle and process benefits claims submitted by healthcare providers.
• Determine eligibility and coverage based on policies and guidelines.
• Assess claims for accuracy, coding, and medical necessity.
• Document claim information in the system with codes and data elements.
• Conduct reviews for discrepancies and validate resolutions.
• Communicate with providers, patients, or stakeholders to resolve issues.
• Ensure compliance with regulatory requirements and company policies.
• Support regular feedback and performance reviews within the team.
• Analyze claims data to identify trends and areas for improvement.

Skills

Customer service

Teamwork

Communication

Time management

Education

High School diploma / GED

Job description

CVS Health is seeking a Claim Benefit Specialist to review and adjudicate benefits claims, verify eligibility, and apply cost-containment measures. You will document claim data, use medical coding rules, and communicate with providers and policyholders.

This 40-hour full-time role includes virtual training for 20 weeks, 8:00-4:30 EST, with a flex schedule after ramp-up. Anticipated weekly hours: 40, pay range: $17.00–$28.46 per hour, depending on experience and geography.