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Claim Benefit Specialist - Onsite in Plantation, FL

7 days ago Plantation, FL

At 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 people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing members and providers with high quality claim adjudication. May handle customer service inquiries and problems.

Additional Responsibilities:

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- Applies medical necessity guidelines, identifies discrepancies, and applies all cost containment. Measures to assist in the claim adjudication process.

- Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures.

- Identifies and reports possible claim overpayments, underpayments and any other irregularities.

- Performs claim rework calculations.
- Ensures accurate and timely claims processingThe hours for this position are Monday-Friday from 8:00am-4:30pmRequired Qualifications

Applicant must have at least 2 years of experience in the following areas:

- Proficient in basic computer operations and software applications

- Experience working in a production- driven environment.

- Demonstrated ability to handle multiple assignments efficiently, accurately and efficiently.

- Strong oral and written communication abilities.Preferred Qualifications

- Familiarity with medical terminology .

- Hands on experience in end-to-end medical claims processing.

- Knowledge of the ACAS system.Education

- High School Diploma or GED equivalent. Anticipated Weekly Hours
40Time Type
Full timeThe hours listed below are the required availability for this role. Please only apply if you can meet these schedule requirements.Shift Flexibility:

Monday: -

Tuesday: -

Wednesday: -

Thursday: -

Friday: -

Saturday: -

Sunday: -

Weekend Shift Frequency:LanguagePay Range

The typical pay range for this role is:$17.00 - $28.46This 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 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 https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 08/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Plantation, FL
Job ID: CVS-R0666809
Employment Type: FULL_TIME
Posted: 2025-08-07T12:41:51

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • HSA
    • HSA With Employer Contribution
    • Pet Insurance
    • Mental Health Benefits
  • Parental Benefits

    • Fertility Benefits
    • Adoption Assistance Program
    • Family Support Resources
  • Work Flexibility

    • Flexible Work Hours
    • Remote Work Opportunities
    • Hybrid Work Opportunities
  • Office Life and Perks

    • Vacation and Time Off

      • Paid Vacation
      • Paid Holidays
      • Personal/Sick Days
    • Financial and Retirement

      • 401(K) With Company Matching
    • Professional Development

      • Tuition Reimbursement
    • Diversity and Inclusion

      • Employee Resource Groups (ERG)
      • Diversity, Equity, and Inclusion Program