If you’ve got the New York Independent Adjuster License, this is a legit “senior” claims seat: complex adjudication, appeals, and being the person other folks tap when the claim gets messy.
About CVS Health
CVS Health is a major health solutions company focused on making care more connected, convenient, and compassionate through local and digital channels.
Schedule
- Full-time (40 hours/week)
- Remote
- Application window closes: 02/27/2026
What You’ll Do
- Review and adjudicate complex or sensitive claims using plan processing guidelines
- Apply medical necessity guidelines, confirm coverage, verify eligibility, and resolve discrepancies
- Use cost containment measures during adjudication
- Handle phone and written inquiries for pre-approval, pre-authorization, reconsiderations, and appeals
- Ensure compliance requirements are met and payments follow company practices
- Identify and report overpayments, underpayments, and irregularities
- Perform claim rework calculations
- Make outbound calls to gather missing/required claim information
- Distribute daily work assignments to junior staff
- Train and mentor Claim Benefit Specialists; act as a subject matter expert
What You Need
- New York Independent Adjuster License (required)
- Experience working in a production environment
- Ability to handle multiple assignments accurately and efficiently
- High school diploma (required)
Preferred
- 18+ months medical claim processing experience
- Self-funding experience
- DG system knowledge
- Associate’s degree or equivalent work experience
Benefits
- Medical plan options
- 401(k) with matching company contributions
- Employee stock purchase plan
- No-cost wellness programs (screenings, tobacco cessation, weight management)
- Confidential counseling + financial coaching
- PTO, flexible schedules, family leave, dependent care resources
- Tuition assistance (and other benefits based on eligibility)
Pay
- $18.50 – $42.35/hour (actual offer depends on experience, education, geography, and other factors)
- Eligible for bonus/commission/short-term incentives in addition to base pay
One thing I’m not going to sugarcoat: that NY Independent Adjuster License is the gatekeeper here. If you don’t already have it (or can’t get it fast), this posting is a time trap.
Happy Hunting,
~Two Chicks…