Senior Claims Benefit Specialist

Job not on LinkedIn

🔥 12 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $18 - $42 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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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 adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims • Adjudicate complex, sensitive, and/or specialized claims according to claim processing guidelines • Process provider refunds and returned checks • Perform claim adjustments across all dollar amount levels using technical and claims processing expertise • Apply medical necessity guidelines and determine coverage • Complete eligibility verification and identify discrepancies • Apply cost containment measures during claim adjudication • Perform claim re-work calculations • Complete claim overpayments, underpayments, and other irregularities • Review and interpret medical contract language and provider contracts to confirm overpayments and allocate refund checks • Handle telephone and written inquiries regarding pre-approvals/pre-authorizations, reconsiderations, and appeals • Ensure compliance requirements and company payment procedures are satisfied • Review relevant correspondence that may require claim adjustments • Provide job shadowing to less experienced staff when needed • Utilize resource materials to manage job responsibilities

🎯 Requirements

• 2+ years medical claim processing experience • Experience in a production environment • Demonstrated ability to handle multiple assignments competently, accurately, and efficiently • Effective communications, organizational, and interpersonal skills • High School Diploma or GED • DG system claims processing experience preferred • Associate degree preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • 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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