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[Hiring] Claim Benefit Specialist @CVS Health

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Role Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

  • Attendance during the 21 week training period is required.
  • Applicants must reside in the Eastern Standard time zone (EST).

Claim Benefit Specialist

Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service.

  • Determine and understand the coverage provided under a member's health plan.
  • Efficiently use multiple systems and screens to obtain and record claim information.
  • Review claims information to determine the nature of a member's illness or injury.
  • Identify claim cost management opportunities and refer claims for follow up.
  • Make claim payment decisions.
  • Process claims accurately to enhance customer satisfaction and retention.
  • Process claims within quality and production standards.
  • Assist team members in support of achieving team, office, regional, and national goals.

Qualifications

  • Experience in a quality and production environment.
  • Attention to detail.
  • Ability to use multiple computer applications at one time.
  • Claim processing experience.

Requirements

  • Associates degree.
  • High School diploma or equivalent.

Benefits

  • Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
  • Medical, dental, and vision coverage.
  • Paid time off.
  • Retirement savings options.
  • Wellness programs and other resources, based on eligibility.

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

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