Senior Claim Benefit Specialist
3 days ago
Description A Brief OverviewReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines.What you will doExecutes 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.For this role you will need Minimum Requirements2+ years of experience with medical claim processing.2+ years of experience in a production environment.Preferred QualificationsDemonstrated ability to handle multiple assignments competently, accurately, and efficiently.Effective communication, organizational, and interpersonal skills.EducationHigh school diploma or equivalent required.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $35.29This 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. 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.Great benefits for great peopleWe 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.For more information, visit We anticipate the application window for this opening will close on: 01/06/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Senior Claim Benefit Specialist
3 days ago
Franklin, United States CVS Health Full timeClaims Adjudication SpecialistAt 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.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000...
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Senior Claim Benefit Specialist
5 days ago
Franklin, United States CVS Health Full timeAt 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.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
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Claim Benefit Specialist-Medical Reviewer
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Franklin, United States CVS Health Full timeClaim Benefit Specialist-Medical Reviewer page is loaded## Claim Benefit Specialist-Medical Reviewerremote type: Hybridlocations: TN - Franklintime type: Full timeposted on: Posted Todaytime left to apply: End Date: December 16, 2025 (26 days left to apply)job requisition id: R0732865At CVS Health, were building a world of health around every consumer and...
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Claim Benefit Specialist
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Franklin, United States CVS Health Full timeClaim Documentation Review SpecialistAt 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.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000...
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Franklin, United States CVS Health Full timeFinal Expense Claims ProcessorAt 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.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000...
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Franklin, United States CVS Health Full timeAt 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.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
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Claim Benefit Specialist-Medical Reviewer
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Franklin, United States CVS Health Full timeAt 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.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
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Franklin, United States CVS Health Full timeA leading health solutions company is seeking a Claim Benefit Specialist-Medical Reviewer in Franklin, TN. The role involves reviewing medical records, assessing policy applications, and ensuring compliance with regulatory standards. Candidates should have a high school diploma, analytical skills, and proficiency in MS Word and Excel. This position offers...
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Benefits Data Entry Specialist
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Senior Claims Processor
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Franklin Lakes, New Jerssy, United States millenniumsoft Full timePosition : Senior Claims ProcessorLocation : Franklin Lakes, NJDuration : 6 months contractTotal Hours/week : 25.005 Hours per dayDescription:The primary responsibility of this position is the investigation, analysis, resolution, trending and corrective action of all claims/complaints. Claim support is responsible to ensure claims are file in a timely...
