Claim Benefit Specialist

About the Role

Join CVS Health and contribute to creating a healthier, more accessible healthcare environment. As a Claim Benefit Specialist, you will review and process medical claims, ensuring accuracy, compliance, and timely reimbursement. You will collaborate with healthcare providers and members to verify policy coverage and validate claims, supporting an efficient claims handling process.

Key Responsibilities

• Attend and complete a mandatory 21-week training program with full attendance.
• Review and process claims submitted by healthcare providers, ensuring adherence to company policies and accuracy.
• Verify eligibility and coverage details against individual insurance plans and policy rules.
• Assess claims for appropriate coding, medical necessity, and required documentation.
• Accurately document claim details within company systems using correct codes and modifiers for tracking and reporting.
• Perform further investigation and review on claims that need additional validation.
• Ensure all claims processing comply with regulatory guidelines, industry standards, and internal policies.
• Be prepared to work overtime after training as required by business needs.
• Restrict work location to residents within Central, Mountain, or Pacific Standard Time zones.

Qualifications and Experience

• Minimum of one year experience in claims processing, healthcare call center roles, or related customer service.
• Comfortable with computer applications and software relevant to claims processing.
• Experience working in fast-paced production environments.
• Ability to maintain performance metrics related to quality, production, and turnaround time.
• Strong organizational and teamwork capabilities.
• Preferred: ability to multitask and work independently or collaboratively.

Education

High School diploma or equivalent GED required.

Work Schedule

Full-time position, typically 40 hours per week.

Compensation

The pay range for this position is $17.00 to $28.46 per hour, with actual salary dependent on experience, education, and location.

Benefits

This full-time job offers a benefits package covering medical, dental, and vision insurance, paid time off, retirement savings plans, wellness programs, and additional support resources, all contingent on eligibility. More specific benefits information is provided during the hiring process.

Additional Information

• Applicants with arrest or conviction records will be considered in compliance with applicable laws.
• The application window closes on 08/28/2026.