Help ensure complex medical claims get handled accurately, fairly, and in compliance, especially when they fall outside standard processing. This role is built for someone who can manage high-volume work, resolve tough claim issues, and serve as a go-to resource for others.
About CVS Health
CVS Health is a leading health solutions company serving millions through local presence and digital channels, supported by 300,000+ colleagues focused on making health care more connected, convenient, and compassionate.
Schedule
- Full time (40 hours)
- Remote
What You’ll Do
- Review and adjudicate complex, sensitive, and specialized claims following plan guidelines
- Apply medical necessity guidelines, determine coverage, verify eligibility, and identify discrepancies
- Apply cost containment measures as part of the claims adjudication process
- Handle phone and written inquiries for pre-approvals, pre-authorizations, reconsiderations, and appeals
- Ensure compliance requirements are met and payments align with company practices and procedures
- Identify and report possible overpayments, underpayments, and other irregularities
- Perform claim rework calculations
- Distribute daily work assignments to junior staff
- Train and mentor claim benefit specialists
- Make outbound calls to obtain required information for claims or reconsiderations
What You Need
- New York Independent Adjuster License
- Experience working in a production environment
- Ability to manage multiple assignments accurately and efficiently
- High School Diploma
Benefits
- Affordable medical plan options
- 401(k) plan with company matching contributions
- Employee stock purchase plan
- No-cost wellness programs (screenings, tobacco cessation, weight management)
- Confidential counseling and financial coaching
- Paid time off and flexible work schedules (depending on eligibility)
- Family leave and dependent care resources
- Tuition assistance and additional colleague assistance programs (depending on eligibility)
The application window closes 02/27/2026.
If you want a stable remote role with clear processes, high accuracy expectations, and opportunities to support others through coaching and training, this is worth a serious look.
Happy Hunting,
~Two Chicks…