Claim Benefit Specialist

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. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

We are looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. The candidates will review and adjudicate claims in accordance with ACAS claim processing guidelines.  They will work closely with other members of the Commercial Services Operations team providing root cause analysis and precise resolution of affected claims.

The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date. They must be detail-oriented, quality minded, be a team player, and meet expected results.
The candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large-scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns.

**On-Site if in commutable distance to Hartford CT; Woonsocket, Cumberland, Smithfield, RI. If outside of commutable distance, will be remote**

Required Qualifications

• Experience in a production environment.
• Proven ability to provide excellent service by meeting key performance metrics including production, quality, and turnaround time.
• Possess strong teamwork and organizational skills.
• Demonstrated ability to handle multiple assignments competently, accurately and efficiently.

Preferred Qualifications

• ACAS claim system experience.
• Detail oriented, root cause problem solving, organized and able to manage multiple priorities.

Education

• High School Diploma.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.  
 

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 people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.