Claim Benefits Specialist Operations

16 hours ago


Jacksonville, Florida, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Claim Benefits Specialist to join our team. As a key member of our operations team, you will be responsible for reviewing and adjudicating complex claims in accordance with claim processing guidelines.

Key Responsibilities
  • Review and adjudicate complex claims in accordance with claim processing guidelines
  • Analyze and approve routine claims that cannot be auto-adjudicated
  • Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply cost containment measures
  • Route and triage complex claims to Senior Claim Benefits Specialist
  • Proof claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis, and pre-coding requirements
Requirements
  • Experience in a production environment
  • Medical claim processing experience preferred but not required
  • Medical coding background a plus but not required
  • Experience with Excel, Word, Teams, and Outlook
Benefits

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also provide a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs.

As a CVS Health employee, you will enjoy paid time off, paid holidays, and a CVS store discount. We are an equal opportunity and affirmative action employer, committed to diversity and inclusion in the workplace.



  • Jacksonville, Florida, United States CVS Health Full time

    Job SummaryWe are seeking a skilled Claim Benefit Specialist Operations to join our team at CVS Health. As a key member of our operations team, you will play a critical role in ensuring the smooth processing of healthcare claims.Key ResponsibilitiesReview and adjudicate routine claims in accordance with claim processing guidelines.Analyze and approve routine...

  • Claims Specialist

    3 weeks ago


    Jacksonville, Florida, United States Paul Davis Restoration, Inc. Full time

    Job Title: Claims SpecialistAt Paul Davis Restoration, Inc., we are seeking a highly skilled Claims Specialist to join our team. As a Claims Specialist, you will play a critical role in ensuring that our customers receive the highest level of service and support in the event of a property damage emergency.Key Responsibilities:Conduct thorough and accurate...


  • Jacksonville, Florida, United States LotSolutions, Inc. Full time

    Job SummaryLotSolutions, Inc. is seeking a highly skilled Claims Operations Analyst to join our team. As a key member of our operations team, you will play a crucial role in enhancing claims operational efficiency and productivity.Key ResponsibilitiesCollaborate with stakeholders to collect and consolidate user requirements, ensuring the development of...


  • Jacksonville, Florida, United States LotSolutions, Inc. Full time

    Job Title: Claims Operations AnalystJob Summary:The Claims Operations Analyst plays a crucial role in enhancing claims operational efficiency and productivity. This position involves gathering, analyzing, and specifying business needs of stakeholders, including customers and end users. The Analyst will collaborate with key stakeholders to collect and...

  • Claims Specialist

    4 weeks ago


    Jacksonville, Florida, United States Onslow Memorial Hospital Full time

    Job SummaryOnslow Memorial Hospital seeks a skilled Claims Analyst Specialist to join our team. The successful candidate will be responsible for tracking, reviewing, and following up on outstanding patient accounts, ensuring timely and accurate payment from third-party payers.Key ResponsibilitiesReview and analyze patient accounting data, clearinghouse...


  • Jacksonville, Florida, United States Southeast Orthopedic Specialists Full time

    Job Title: Insurance Follow-Up RepresentativeJoin Southeast Orthopedic Specialists, a regional leader in musculoskeletal medicine, as we continue to grow and expand our services. We are seeking a highly skilled Insurance Follow-Up Representative to join our Central Business Office in Jacksonville, FL.Job Summary:We are looking for a detail-oriented and...

  • Claims Specialist

    16 hours ago


    Jacksonville, Florida, United States Onslow Memorial Hospital Full time

    Job SummaryThe Claims Analyst Specialist is a key member of our team at Onslow Memorial Hospital, responsible for ensuring timely and accurate payment from third-party payers. This role requires a strong understanding of payer systems, billing codes, and claim formats.Key ResponsibilitiesTrack, review, and follow up on outstanding patient accounts, including...

  • Claims Specialist

    1 week ago


    Jacksonville, Florida, United States Onslow Memorial Hospital Full time

    Job SummaryThe Claims Analyst Specialist plays a critical role in ensuring timely and accurate payment from third-party payers. This position is responsible for tracking, reviewing, and following up on outstanding patient accounts, including reviewing patient accounting desktop, clearinghouse billing lists, and intermediary online error lists. The ideal...


  • Jacksonville, Florida, United States LotSolutions, Inc. Full time

    Job Title: Claims ManagerLotSolutions, Inc. is seeking a highly skilled and experienced Claims Manager to lead and manage the Claims Operations team. The successful candidate will be responsible for developing and maintaining procedures and guidelines to achieve the company's objectives effectively and efficiently.Key Responsibilities:Develop and implement...


  • Jacksonville, Florida, United States LotSolutions, Inc. Full time

    Job Title: Claims ManagerLotSolutions, Inc. is seeking a highly skilled and experienced Claims Manager to lead and manage the Claims Operations team. The successful candidate will be responsible for developing and maintaining procedures and guidelines to achieve the company's objectives effectively and efficiently.Key Responsibilities:Develop and implement...


  • Jacksonville, Florida, United States Southeast Orthopedic Specialists Full time

    Job Title: Auto Injury Program SpecialistAt Southeast Orthopedic Specialists, we are seeking a highly organized and detail-oriented Auto Injury Program Specialist to join our team. As a key member of our medical office, you will play a crucial role in ensuring the smooth operation of our auto injury program.Key Responsibilities:Manage patient charts and...


  • Jacksonville, Florida, United States The Center for Orthopedic and Research E Full time

    Job Title: Auto Injury Program SpecialistWe are seeking a highly organized and detail-oriented Auto Injury Program Specialist to join our team at The Center for Orthopedic and Research E. As a key member of our staff, you will play a crucial role in ensuring the smooth operation of our medical billing and insurance verification processes.Key...

  • Claims Examiner

    2 weeks ago


    Jacksonville, Florida, United States Jobot Full time

    Claims Examiner Job DescriptionWe are seeking a seasoned Claims Examiner to join our dynamic team at Jobot. As a Claims Examiner, you will play a crucial role in analyzing and resolving a variety of insurance claims.Key Responsibilities:Evaluate and investigate insurance claims promptly and accurately, ensuring all necessary documentation is available and...

  • Claims Examiner

    2 days ago


    Jacksonville, Florida, United States Jobot Full time

    Claims Examiner Job DescriptionAt Jobot, we're seeking a seasoned Claims Examiner to join our dynamic team. As a Claims Examiner, you'll play a crucial role in analyzing and resolving a variety of insurance claims.Key Responsibilities:Evaluate and investigate insurance claims promptly and accurately, ensuring all necessary documentation is available and...

  • Claims Examiner

    4 weeks ago


    Jacksonville, Florida, United States Jobot Full time

    {"title": "Claims Examiner", "description": "Job SummaryWe are seeking an experienced Claims Examiner to join our dynamic team. As a Claims Examiner, you will play a crucial role in analyzing and resolving a variety of insurance claims.Key ResponsibilitiesEvaluate and investigate insurance claims promptly and accurately, ensuring all necessary documentation...


  • Jacksonville, Florida, United States City of Jacksonville, FL Full time

    Job Title: Workers' Compensation SpecialistJob Summary: We are seeking a highly skilled Workers' Compensation Specialist to join our team at the City of Jacksonville, FL. As a key member of our finance department, you will be responsible for monitoring, reviewing, and processing workers' compensation claims. Your expertise in workers' compensation laws,...


  • Jacksonville, Florida, United States City of Jacksonville, FL Full time

    Job Title: Workers' Compensation SpecialistWe are seeking a highly skilled Workers' Compensation Specialist to join our team at the City of Jacksonville, FL. As a key member of our Finance Department, you will be responsible for monitoring, reviewing, and processing workers' compensation claims.Key Responsibilities:Monitor and review workers' compensation...


  • Jacksonville, Florida, United States City of Jacksonville Full time

    Job SummaryWe are seeking a highly skilled Workers' Compensation Specialist to join our team at the City of Jacksonville. As a key member of our Finance Department, you will be responsible for monitoring, reviewing, and processing workers' compensation claims. If you have a strong background in workers' compensation laws, rules, and regulations, and...

  • Claims Processor 1

    4 weeks ago


    Jacksonville, Florida, United States First Coast Service Options, Inc. Full time

    Claims Processor Job SummaryWe are seeking a skilled Claims Processor to join our team at First Coast Service Options, Inc. As a Claims Processor, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.Key Responsibilities:Prepare and process claims in a timely and accurate mannerResolve basic on-line edits...

  • Claims Processor 1

    4 weeks ago


    Jacksonville, Florida, United States First Coast Service Options, Inc. Full time

    Job SummaryWe are seeking a skilled Claims Processor to join our team at First Coast Service Options, Inc. As a Claims Processor, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.Key ResponsibilitiesPrepare and process claims in a timely and accurate mannerResolve basic on-line edits and perform data...