Senior Claim Benefit Specialist - Remote

Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience.

• Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines.
• Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues.
• Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience.

• Minimum of 18 months of medical claim processing experience with a health insurance payor or third-party administrator.
• Proven success working in a high-volume, production-driven environment.
• Demonstrated ability to manage multiple assignments with accuracy, efficiency, and attention to detail.

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.