Senior Claim Benefit Specialist

May 13, 2024

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Job Description

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand ? with heart at its center ? our purpose sends a personal message that how we deliver our services is just as important… as what we deliver.
Our Heart At Work Behaviors? support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.
– Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
– Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.
– Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.
– Identifies and reports possible claim overpayments, underpayments and any other irregularities.
– Performs claim rework calculations.
– Makes outbound calls to obtain required information for claim or reconsideration.
Required Qualifications
Required 2+ years of Medical claims processing experience
Familiar with ICD and CPT coding
Ability to multitask while working independently
Preferred Qualifications
Required 2+ years of Medical claims processing experience
Familiar with ICD and CPT coding
Ability to multitask while working independently
Request a minimum of an Associate’s degree which will be waived in lieu of medical claims processing experience.
Pay Range
The typical pay range for this role is:
$18.50 – $35.29
This 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company?s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (?PTO?) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit
This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis

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