Claim Benefit Specialist

Location: PA - Work from home, Work At Home-Ohio, Work At Home-Georgia, Work At Home-Vermont, Work At Home-West Virginia, Work At Home-Maryland, Work At Home-Massachusetts, Work At Home-Michigan, Work At Home-Maine, Work At Home-New York, Work At Home-Virginia, Work At Home-District of Columbia, Work At Home-North Carolina, Work At Home-Florida, Work At Home-Connecticut, Work At Home-New Jersey, Work At Home-New Hampshire, Work At Home-Rhode Island, Work At Home-Delaware, Work At Home-Tennessee

Remote Type: Remote/Hybrid

Time Type: Full time

Job Description

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.

- Attendance during the 21 week training period is required. After completion of the training period, overtime may be required based on business needs.

- Applicants must reside in the Eastern Time Zone (EST)

Job Summary

Reviews and adjudicates claims in accordance with claim processing guidelines. Claim Benefit Specialists have the opportunity to enhance and improve member satisfaction and retention by providing accurate and timely resolution in processing medical claims. You will be a key link in providing our customers with prompt, efficient, high quality claim service.

We are looking for a detail oriented individual who enjoys working in a team environment and can create value for our customers by exceeding high quality metrics.

Attendance during the 21 week training period is required. After completion of the training period, overtime may be required based on business needs.

Additional Responsibilities to include but not limited to the following:

- Determine and understand the coverage provided under a members health plan

- Efficiently use multiple systems and screens to obtain and record claim information

- Review claims information to determine the nature of a members illness or injury

- Identify claim cost management opportunities and refer claims for follow up

- Make claim payment decisions

- Process claims accurately to enhance customer satisfaction and retention

- Process claims within quality and production standards

- Assist team members in support of achieving team, office, regional, and national goals

Required qualifications

- Experience in a quality and production environment.

- Attention to detail.

- Ability to use multiple computer applications at one time.

Preferred qualifications

- Prior medical claim processing experience is a plus.

- Exceptional analytical skills, accurate and fast keyboarding skills, advanced computer navigation and knowledge and experience in a Windows environment

- Effective verbal and written communication skills

- Ability to adapt quickly and willingly to change, and a positive, willing attitude.

- Successful candidates should be comfortable with quality goals, production goals, and service expectations and will be monitored for accuracy, efficiency, and customer satisfaction.

- Associate’s Degree

Education

High School Diploma or equivalent GED

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $34.15

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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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

We anticipate the application window for this opening will close on: 09/18/2026

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