Be part of a team transforming healthcare for millions of Americans. CVS Health is seeking a Senior Claim Benefit Specialist to review and adjudicate complex claims, mentor junior staff, and act as a subject matter expert ensuring accuracy and compliance.
About CVS Health
CVS Health is the nation’s leading health solutions company, serving millions of people through local presence, digital channels, and more than 300,000 dedicated colleagues. Our mission is to deliver connected, convenient, and compassionate care—putting heart into everything we do.
Schedule
- Full-time, remote role (available in 50 locations)
- 40 hours per week
What You’ll Do
- Review and adjudicate complex or sensitive claims following company guidelines
- Apply medical necessity rules, verify eligibility, and identify discrepancies
- Handle pre-approval, reconsideration, and appeal inquiries via phone or written communication
- Ensure compliance with HIPAA, company policy, and regulatory requirements
- Identify and report overpayments, underpayments, and irregularities
- Perform claim rework calculations and distribute work assignments
- Train, mentor, and support junior claim specialists
- Make outbound calls to collect required information for claims or reconsiderations
What You Need
- High School Diploma required (Associate degree preferred)
- New York Independent Adjuster License
- Experience in a production environment with multiple assignments
- Strong organizational, accuracy, and efficiency skills
Preferred Qualifications
- 18+ months of medical claim processing experience
- Knowledge of self-funding practices
- Familiarity with DG systems
Benefits
- Competitive hourly pay range: $18.50 – $42.35, plus eligibility for bonuses or incentives
- Affordable medical, dental, and vision plans
- 401(k) plan with company match and employee stock purchase program
- Paid time off, flexible scheduling, and family leave
- Wellness programs, financial coaching, tuition assistance, and retiree medical access
- Comprehensive support for physical, emotional, and financial well-being
Join CVS Health and bring expertise, accuracy, and compassion to the claim process.
Happy Hunting,
~Two Chicks…