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.
Position Summary
We are looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. The candidates will review and adjudicate claims in accordance with ACAS claim processing guidelines. They will work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims.
The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date. They must be detail-oriented, quality minded, be a team player, and meet expected results.
The candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns.
**On-Site if in commutable distance to Hartford CT; Woonsocket, Cumberland, Smithfield, RI. If outside of commutable distance, will be remote**
Required Qualifications
- Experience in a production environment.
- Proven ability to provide excellent service by meeting key performance metrics including production, quality, and turnaround time.
- Possess strong teamwork and organizational skills.
- Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Preferred Qualifications
- ACAS claim system experience.
- Detail oriented, root cause problem solving, organized and able to manage multiple priorities.
Education
- High School Diploma.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $31.30This 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 production environment
- Ability to meet production, quality, and turnaround-time performance metrics
- Strong teamwork and organizational skills
- Ability to manage multiple assignments accurately and efficiently
- High school diploma
- ACAS claim system experience
- Detail-oriented root-cause problem-solving ability
- Ability to manage multiple priorities
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.
