Senior Claim Benefit Specialist - Remote

Overview

The Senior Claim Benefit Specialist at CVS Health is responsible for reviewing and adjudicating complex claims while providing training and support to junior staff.

In Short

• Reviews and adjudicates complex claims.
• Acts as a subject matter expert and provides training.
• Handles customer service inquiries related to claims.
• Applies medical necessity guidelines and determines coverage.
• Ensures compliance with company practices.
• Identifies and reports claim discrepancies.
• Trains and mentors junior claim specialists.
• Makes outbound calls for required information.
• Works in a production environment.
• Full-time position with competitive benefits.

Requirements

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

Benefits

• Comprehensive 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 dependent care resources.
• Confidential counseling and financial coaching.
• Retiree medical access.