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Senior Claim Benefit Specialist
4 weeks ago
Position Summary At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. We reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day. Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. May handle customer service inquiries and problems. What You Will Do Executes both routine and non-routine business support tasks for the Claim Benefit area under limited supervision, referring deviations from standard practices to managers. Follows area protocols, standards, and policies to provide effective and timely support. Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. Handles phone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Identifies and reports claim overpayments, underpayments, and any other irregularities. Takes direction to execute techniques, processes, and responsibilities. Required Qualifications 3+ years medical claim processing experience. Working knowledge of problem solving and decision making skills. Preferred Qualifications Self-Funding experience. Education High school diploma or equivalent required. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $42.35. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional, and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. We anticipate the application window for this opening will close on: 11/14/2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
