Claim Benefit Specialist

CVS Health • Hartford, CT

2d

About The Position

CVS Health is seeking a highly motivated Claim Benefit Specialist to review and rework sensitive, complex medical and hospital claims for its rework project department. The specialist works with the Commercial Services Operations team to conduct root cause analysis and resolve affected claims accurately and by project deadlines. The role processes medical and hospital claims for rework projects, compliance, and complex issues involving specific providers or networks, as well as large-scale projects arising from plan sponsor issues, release fallout, or legal, regulatory, and compliance concerns.

Requirements

• At least 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a related healthcare administrative role.
• Strong analytical and problem-solving skills, including the ability to research and resolve complex claim issues.
• Ability to manage multiple priorities while meeting quality and turnaround-time expectations.
• Strong attention to detail and commitment to accuracy.
• Proficiency in Microsoft Excel, including sorting, filtering, and basic data analysis.
• Ability to work effectively in a fast-paced environment and adapt to changing business needs.
• High school diploma or equivalent.

Nice To Haves

• Experience in healthcare, insurance, claims processing, medical billing, or customer service.
• Knowledge of medical terminology, insurance benefits, or healthcare operations.
• Experience using computer systems to research and resolve customer or claim-related issues.
• Ability to work independently and collaboratively in a team environment.
• Strong organizational and time-management skills.
• Adaptability and willingness to learn new processes and systems.

Responsibilities

• Review and rework sensitive, complex medical and hospital claims.
• Provide root cause analysis and precise resolution of affected claims in collaboration with the Commercial Services Operations team.
• Ensure rework project claims are resolved accurately, routed to appropriate areas, and handled by their due dates.
• Process medical and hospital claims for rework projects, compliance, and complex issues involving providers, networks, or large-scale projects.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED