Senior Claim Benefit Specialist – Operations, Encounters

Job not on LinkedIn

🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 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.

Apply Now

Find Similar Remote Jobs

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

• Research, review, and adjudicate complex, sensitive, and specialized encounters according to state-specific processing guidelines • Drive timely resolution of encounter errors using available resources, tools, and research • Adjudicate complex, sensitive, and specialized claims accurately in the claims processing system • Meet quality and production expectations • Identify and escalate issues affecting claim payment accuracy or causing rework • Partner cross-functionally to resolve barriers to encounter acceptance • Contribute to developing desktops and standardized procedures • Balance competing priorities while supporting multiple markets • Participate in working sessions and meetings advancing business objectives and KPIs

🎯 Requirements

• Minimum 2 years of medical claims processing experience (Commercial, Medicaid, Medicare) • Experience working in a production environment • Strong analytical and problem-solving skills, especially in researching claims • Proficiency in MS Office Suite applications; Excel, Word, OneNote • Ability to work independently and as a team • QNXT or Facets claims processing experience (preferred) • Experience in Medicaid or Medicare claims (preferred) • Encounters experience (preferred) • Edifecs system knowledge (preferred) • High School Diploma

🏖️ 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

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume