Senior Claim Benefit Specialist - Remote

Overview

As a Senior Claim Benefit Specialist at CVS Health, you will review and adjudicate complex claims, act as a subject matter expert, and provide training and support to colleagues.

In Short

• Review and adjudicate complex claims.
• Act as a subject matter expert for claims processing.
• Handle customer service inquiries related to claims.
• Ensure compliance with processing guidelines.
• Identify and report claim discrepancies.
• Train and mentor junior staff.
• Make outbound calls for additional claim information.
• Perform claim rework calculations.
• Work in a production environment.
• Support the overall mission of CVS Health in transforming health care.

Requirements

• 18+ months of medical claim processing experience.
• Experience in a production environment.
• Ability to handle multiple assignments efficiently.
• High School Diploma required; Associates degree preferred.
• Self-Funding experience is a plus.
• Knowledge of DG systems is preferred.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching contributions.
• Employee stock purchase plan.
• No-cost wellness programs.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave.
• Confidential counseling and financial coaching.
• Comprehensive benefits for physical, emotional, and financial wellness.