Claim Benefit Specialist

About the role

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.

Responsibilities

• Reviews and adjudicates claims in accordance with claim processing guidelines.
• Enhances and improves member satisfaction and retention by providing accurate and timely resolution in processing medical claims.
• Acts as a key link in providing customers with prompt, efficient, high quality claim service.
• Determines and understands the coverage provided under a member's health plan.
• Efficiently uses multiple systems and screens to obtain and record claim information.
• Reviews claims information to determine the nature of a member's illness or injury.
• Identifies claim cost management opportunities and refers claims for follow up.
• Makes claim payment decisions.
• Processes claims accurately to enhance customer satisfaction and retention.
• Processes claims within quality and production standards.
• Assists team members in support of achieving team, office, regional, and national goals.

Requirements

• Experience in a quality and production environment.
• Attention to detail.
• Ability to use multiple computer applications at one time.
• High School Diploma or equivalent GED.

Preferred Qualifications

• Prior medical claim processing experience.
• 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.
• Comfort with quality goals, production goals, and service expectations.

Schedule

• 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).
• Anticipated Weekly Hours: 40.
• Time Type: Full time.

Pay

The Typical Pay Range For This Role Is $17.00 - $34.15. 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.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.