Claim Benefit Specialist

Claim Benefit Specialist

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. 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. High School Diploma or equivalent GED. Anticipated weekly hours : 40. Time type : Full time. Pay range : $17.00 - $34.15. 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. We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include : affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. We anticipate the application window for this opening will close on : 12 / 15 / 2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.