Senior Claim Benefit Specialist - Remote

Overview

As a Senior Claim Benefit Specialist at CVS Health, you will review and adjudicate complex claims while acting as a subject matter expert to train and support junior staff.

In Short

• Review and adjudicate complex claims.
• Provide training and coaching to junior staff.
• Handle customer service inquiries related to claims.
• Apply medical necessity guidelines and determine coverage.
• Ensure compliance with company practices.
• Identify and report claim discrepancies.
• Perform claim rework calculations.
• Make outbound calls for required information.
• Distribute daily work assignments.
• Mentor claim benefit specialists.

Requirements

• 18+ months of medical claim processing experience.
• Experience in a production environment.
• Ability to handle multiple assignments accurately.
• High School Diploma required; Associates degree preferred.
• Self-funding experience preferred.
• DG system knowledge preferred.

Benefits

• Affordable medical plan options.
• 401(k) plan with company matching.
• Employee stock purchase plan.
• No-cost wellness programs.
• Flexible work schedules.
• Tuition assistance.
• Paid time off and family leave.
• Dependent care resources.
• Confidential counseling and financial coaching.
• Retiree medical access.