CVS Health · 18 hours ago
Claim Benefit Specialist
United States
Full-time
Remote
Entry Level
$17/hr - $28.46/hr
1+ years expCVS Health is dedicated to building a world of health around every individual. The Claim Benefit Specialist role involves processing and reviewing benefits claims, ensuring accuracy and compliance with policy guidelines while communicating effectively with healthcare providers and stakeholders.
Health CareMedicalPharmaceuticalRetailSales
Responsibilities
Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines
Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope
Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements
Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims
Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution
Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims
Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies
Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development
Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department
Qualification
Required
1-2 years' experience working in Customer Service
Possess strong teamwork and organizational skills
Strong and effective communication skills
Ability to handle multiple assignments competently through use of time management, accurately and efficiently
Strong proficiency using computers and experience with data entry
Preferred
Experience in a production environment
Healthcare experience
Knowledge of utilizing multiple systems at once to resolve complex issues
Claim processing experience preferred but not required
Understanding of medical terminology
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
2026-01-25
Company data provided by crunchbase