The Claim Benefit Specialist is a full-time, remote position open in multiple states, including Arizona, Mississippi, Montana, North Carolina, and Louisiana, with additional locations listed in the job posting. The role centers on reviewing and processing medical benefit claims accurately and in alignment with established insurance policies.
Role Overview
This position focuses on evaluating documentation, confirming coverage eligibility, and ensuring claims meet coding and compliance standards. Attention to detail and consistent application of policy guidelines are central to daily responsibilities.
- Review claim documentation submitted by healthcare providers
- Verify patient eligibility and coverage based on insurance plan guidelines
- Assess claims for compliance with coding standards, medical necessity, and documentation requirements
- Document claim information accurately within company systems
- Assign appropriate codes and modifiers to support tracking and reporting
- Investigate claims requiring additional validation or scrutiny
- Communicate with providers, patients, or other stakeholders to resolve discrepancies
- Ensure adherence to regulatory requirements, industry standards, and company policies
- Analyze claims data to identify trends or areas for operational improvement
The role also includes participation in structured feedback and performance review processes designed to maintain service quality and support team engagement.
Qualifications and Requirements
Candidates are expected to bring foundational experience in customer-facing environments, along with the ability to work independently in a remote setting. Strong organizational skills and consistent accuracy under workload demands are essential.
Required Qualifications
- 1–2 years of customer service experience
- Strong teamwork and organizational skills
- Clear and effective communication skills
- Ability to manage multiple assignments accurately and efficiently
- Strong proficiency using computers and experience with data entry
- High School diploma or GED equivalent
Preferred Qualifications
- Experience in a production environment
- Healthcare experience
- Experience using multiple systems simultaneously to resolve complex issues
- Claim processing experience (preferred but not required)
- Understanding of medical terminology
Compensation and Benefits
This is a full-time position with an anticipated 40-hour workweek. The typical pay range for this role is:
- $17.00 – $28.46 per hour
Actual compensation is determined by factors such as experience, education, geography, and other relevant considerations.
Benefits described in the posting include:
- Affordable medical plan options
- 401(k) plan with matching company contributions
- Employee stock purchase plan
- No-cost wellness programs, including screenings and tobacco cessation
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules (where applicable)
- Family leave and dependent care resources
- Tuition assistance
- Retiree medical access (based on eligibility)
Career Growth and Company Culture
The role operates within an organization that emphasizes accountability, quality, and safety in healthcare services. Structured performance processes support ongoing development and service excellence.
- Regular performance feedback
- Formal review processes
- Focus on engagement, motivation, and team development
The organization states a commitment to fostering an inclusive workplace where colleagues feel valued and supported. Qualified applicants with arrest or conviction records are considered in accordance with applicable federal, state, and local laws.
Anticipated application deadline: February 16, 2026
About CVS Health
CVS Health describes its mission as building “a world of health around every individual,” with an emphasis on delivering a more connected, convenient, and compassionate healthcare experience. The company serves customers, patients, members, and communities across the United States.
The organization positions its workforce as central to its long-term strategy, highlighting innovation, accountability, safety, and inclusion as core elements of its culture.
Apply to the Claim Benefit Specialist Position with CVS Health