# Claim Benefit Specialist

**Company**: CVS Health
**Location**: Work from home, TN
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $17.00 - $25.65
**Category**: Customer Service
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TN---Work-from-home/Claim-Benefit-Specialist--Commercial-Operations_R1071534?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_3ccc5552-862

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

As a Claim Benefit Specialist, you will perform claim documentation review, verify policy coverage, assess claim validity, communicate with healthcare providers and policyholders, and ensure accurate and timely claims processing.

**Responsibilities**

- Handles and processes benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.

- Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.

- Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.

- Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.

- Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.

- Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.

- Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.

- Analyzes claims data and generates reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.

**Position Summary**

- This is a Claim Benefit Specialist position and will be trained for 20 weeks virtually.

- Shift hours: Flex schedule available after successful ramp up.

**Requirements**

- 1-2 years experience working in Customer Service.

- Possess strong teamwork and organizational skills.

- Strong and effective communication skills.

- Ability to handle multiple assignments competently through use of time management, accurately and efficiently.

**Preferred Qualifications**

- Experience in a production environment.

- Healthcare experience.

- Knowledge of utilizing multiple systems at once to resolve complex issues.

- Claim processing experience preferred but not required.

- Understanding of medical terminology.

**Benefits**

- Medical, dental, and vision coverage.

- Paid time off.

- Retirement savings options.

- Wellness programs.

## Skills

### Required
- Customer Service
- Communication
- Time Management
- Organizational

### Nice to have
- Production Environment
- Healthcare Experience
- Medical Terminology
- Claim Processing

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TN---Work-from-home/Claim-Benefit-Specialist--Commercial-Operations_R1071534?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)