If you’re organized, steady under pressure, and you like work that’s part detective, part admin, this role fits. You’ll review and process medical claims, verify coverage, spot documentation issues, and communicate with providers to resolve discrepancies while keeping accuracy and speed high.
About CVS Health
CVS Health is building a more connected, convenient, and compassionate healthcare experience nationwide. The Federal FFS (fee-for-service) claims team supports accurate claims processing by reviewing documentation, confirming eligibility and coverage, and ensuring compliance with policy and regulatory standards.
Schedule
- Fully remote (North Carolina)
- Full-time: 40 hours per week
- Application window expected to close January 3, 2026
What You’ll Do
⦁ Review and process benefit claims submitted by healthcare providers, ensuring accuracy and adherence to guidelines
⦁ Verify eligibility and benefit coverage based on the member’s plan and policy scope
⦁ Assess claims for coding accuracy, medical necessity, and documentation requirements
⦁ Document claim details in company systems, including codes, modifiers, and required data elements
⦁ Investigate claims that need additional validation or scrutiny to ensure proper resolution
⦁ Communicate with providers, patients, or stakeholders to clear up discrepancies and missing info
⦁ Support compliance by ensuring claim handling aligns with regulatory requirements and internal policies
⦁ Analyze claims data and generate reports to identify trends and improvement opportunities
⦁ Contribute feedback and performance processes that support team development and service quality
What You Need
⦁ 1–2 years of customer service experience
⦁ Strong teamwork, organization, and time management skills
⦁ Clear written and verbal communication skills
⦁ Ability to manage multiple assignments accurately and efficiently
⦁ Strong computer proficiency and data entry experience
⦁ High school diploma or GED
Benefits
⦁ Pay range: $17.00 to $25.65 (varies by experience, location, and qualifications)
⦁ Affordable medical plan options and 401(k) with company match
⦁ Employee stock purchase plan eligibility
⦁ No-cost wellness programs plus confidential counseling and financial coaching
⦁ Paid time off, flexible schedules, family leave, tuition assistance, and other benefits based on eligibility
This posting is expected to close January 3, 2026. If you want a foot-in-the-door claims role where accuracy and focus matter, don’t wait until the last week.
This is the kind of job that builds a real claims career fast if you can stay sharp and consistent.
Happy Hunting,
~Two Chicks…