Claim Benefit Specialist
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 role works closely with the Commercial Services Operations team to perform root cause analysis and resolve affected claims accurately and by project deadlines. The specialist processes claims for rework projects, compliance matters, and complex issues involving specific providers or networks and large-scale projects. These projects may arise from plan sponsor issues, release fallout, or legal, regulatory, or 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.
- Perform root cause analysis and accurately resolve affected claims in collaboration with the Commercial Services Operations team.
- Ensure rework project claims are resolved accurately, routed to appropriate areas, and handled by the project due date.
- Process medical and hospital claims associated with rework projects, compliance matters, and complex provider, network, or large-scale issues.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
