Senior Claim Benefit Specialist

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🔥 0 minutes ago

🍑 Georgia – Remote

🍑 Georgia – Remote

💵 $18 - $42 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review and adjudicate complex, sensitive, and specialized medical claims according to established plan processing guidelines • Serve as a subject matter expert by providing coaching and guidance on escalated or technically challenging issues • Support customer service operations by addressing inquiries and resolving issues • Review pre-specified claims and claims exceeding specialist adjudication authority or processing expertise • Apply medical necessity guidelines, determine coverage, verify eligibility, identify discrepancies, and implement cost-containment measures • Ensure regulatory compliance and confirm payments align with company policies and procedures • Identify and report potential overpayments, underpayments, and other claim irregularities • Perform claim rework calculations • Train and mentor as needed • Conduct outbound calls to obtain required information for claims or reconsideration requests

🎯 Requirements

• Minimum of 18 months of medical claim processing experience with a health insurance payor or third-party administrator • Proven success working in a high-volume, production-driven environment • Demonstrated ability to manage multiple assignments with accuracy, efficiency, and attention to detail • High School Diploma required • Self-Funding experience preferred • DG system knowledge preferred • Associates degree or equivalent work experience preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility

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