📍 Remote | Open in 51 Locations
🏢 CVS Health
📌 Position Summary
CVS Health is hiring a Senior Claim Benefit Specialist to handle complex and sensitive medical claims while supporting internal teams with training, mentorship, and subject-matter expertise. This fully remote, full-time role is ideal for detail-oriented professionals with prior medical claims processing experience who thrive in fast-paced, high-volume environments.
💼 Key Responsibilities
• Review and adjudicate complex or escalated medical claims
• Apply medical necessity guidelines, verify eligibility, and flag discrepancies
• Conduct claim rework calculations and identify over/underpayments
• Manage pre-authorization, reconsiderations, and appeals
• Communicate with providers and members to gather required documentation
• Train and mentor junior claim benefit specialists
• Handle both phone and written inquiries; make outbound calls as needed
• Ensure full compliance with internal policies and external regulations
• Distribute daily workloads within the team
💡 Why This Role Is a Fit
• Work from home with nationwide reach
• Use your claims knowledge to directly impact patient outcomes
• Join a Fortune 5 company transforming healthcare from the inside out
📋 Requirements
✔️ Required:
• Active New York Independent Adjuster License
• Previous experience in a production-driven environment
• Proven ability to manage multiple priorities under deadlines
✔️ Preferred:
• 18+ months of medical claim processing experience
• Familiarity with DG systems and self-funded plans
📚 Education:
• High school diploma required
• Associate’s degree or equivalent experience preferred
💰 Pay & Benefits
• Pay Range: $18.50 – $42.35/hr (based on experience and location)
• Weekly Hours: 40 (Full-time)
• Incentives: Eligible for CVS Health bonuses and short-term incentives
• Benefits:
- Comprehensive health plans
- 401(k) with company match
- Stock purchase options
- Wellness resources and paid time off
- Flexible scheduling, family leave, tuition support
🗓️ Application Deadline: October 1, 2025
✨ If you’re ready to use your claims expertise to shape better healthcare from behind the scenes—while working from home—this is your chance.
Your next move? Start here.
Let’s reimagine health, together.
~ 2 Chicks