We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
- Attendance during the 21 week training period is required. After completion of the training period, overtime may be required based on business needs.
- Applicants must reside in the Eastern Time Zone (EST)
Job Summary
Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service.
We are looking for a detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics.
Attendance during the 21 week training period is required. After completion of the training period, overtime may be required based on business needs.
Additional Responsibilities to include but not limited to the following:
- Determine and understand the coverage provided under a member's health plan
- Efficiently use multiple systems and screens to obtain and record claim information
- Review claims information to determine the nature of a member's illness or injury
- Identify claim cost management opportunities and refer claims for follow up
- Make claim payment decisions
- Process claims accurately to enhance customer satisfaction and retention
- Process claims within quality and production standards
- Assist team members in support of achieving team, office, regional, and national goals
Required qualifications
- Experience in a quality and production environment.
- Attention to detail.
- Ability to use multiple computer applications at one time.
Preferred qualifications
- Prior medical claim processing experience is a plus.
- Exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment
- Effective verbal and written communication skills
- Ability to adapt quickly and willingly to change, and a positive, willing attitude.
- Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction.
- Associate’s Degree
Education
High School Diploma or equivalent GED
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $34.15This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Experience in a quality and production environment
- Attention to detail
- Ability to use multiple computer applications simultaneously
- High school diploma or equivalent GED
- Prior medical claims processing experience
- Exceptional analytical skills
- Accurate and fast keyboarding skills
- Advanced computer navigation skills and Windows experience
- Effective verbal and written communication skills
- Ability to adapt quickly to change and maintain a positive attitude
- Associate's degree
- Residence in the Eastern Time Zone
- Attendance during the 21-week training period
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
