Claim Benefit Specialist

Job not on LinkedIn

🔥 14 hours ago

🏈 Alabama, Arizona, +42 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.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

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Handle and process benefits claims submitted by healthcare providers • Determine benefit eligibility and coverage based on insurance plans and policy guidelines • Assess claims for accuracy, coding compliance, medical necessity, and documentation requirements • Document claim information, codes, modifiers, and other data in company systems • Review and investigate claims requiring additional scrutiny or validation • Communicate with healthcare providers, patients, and stakeholders to resolve discrepancies • Ensure claims processing complies with regulatory requirements, industry standards, and company policies • Review and adjudicate routine claims according to processing guidelines • Analyze and approve routine claims that cannot be auto-adjudicated • Apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost-containment measures • Coordinate responses to routine phone inquiries and written correspondence • Route and triage complex claims to the Senior Claim Benefits Specialist • Proof claim or referral submissions and apply appropriate guidelines, coding, member identification, diagnosis, and pre-coding requirements • Facilitate training when serving as a subject matter expert • Manage claims, queues, and ECHS within specified turnaround-time parameters • Use applicable system functions, including claim check, reasonable and customary data, and post-containment tools • Develop and implement feedback and performance review processes • Analyze claims data and generate reports to identify trends and improvement opportunities

🎯 Requirements

• Less than 1 year work experience • Working knowledge of problem solving and decision making skills • High school diploma or equivalent required • Experience in a production environment • Claims processing experience in any field • Preferred: Medicaid • Preferred: QNXT • Preferred: Medical Coding • Preferred: Microsoft Outlook/Excel • Ability to adhere to a 20-week training schedule • Ability to work Monday through Friday, 9AM–5:30PM EST (8AM–4:30PM CST, 7AM–3:30PM MST, 6AM–2:30PM PST)

🏖️ 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