Senior Claim Benefit Specialist – Encounters

CVS Health Careers

. Research, review, and adjudicate complex, sensitive, and specialized encounters according to state-specific processing guidelines .

Posted 11/9/2026full-timeRemote • Arizona • United StatesSenior💰 $19 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing, particularly in Commercial, Medicaid, and Medicare environments, while effectively resolving encounter errors and ensuring claim payment accuracy. Strong analytical skills and proficiency in MS Office Suite enhance the ability to meet quality and production expectations.

Highest-signal resume keywords

Medical Claims Processing ExperienceAnalytical SkillsProblem-Solving SkillsMS Office Suite ProficiencyQNXT Claims Processing Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ProcessingEncounter AdjudicationClaims Processing SystemResearch SkillsQuality AssuranceProduction Environment ExperienceAnalytical SkillsProblem-Solving Skills

Soft Skills

Team CollaborationIndependent WorkTime Management

Tools & Technologies

MS Office SuiteQNXTFacetsEdifecs

Industry Keywords

MedicaidMedicareClaims ProcessingEncounter ResolutionCross-Functional Partnership

About the role

Key responsibilities & impact

Research, review, and adjudicate complex, sensitive, and specialized encounters according to state-specific processing guidelines
Drive timely resolution of encounter errors using available resources, tools, and research
Adjudicate complex, sensitive, and specialized claims accurately in the claims processing system
Meet quality and production expectations
Identify and escalate issues affecting claim payment accuracy or creating rework
Partner cross-functionally to resolve barriers to encounter acceptance
Contribute to desktops and standardized procedures
Balance competing priorities while supporting multiple markets
Participate in working sessions and meetings advancing business objectives and KPIs

Requirements

What you’ll need

Minimum 2 years of medical claims processing experience (Commercial, Medicaid, Medicare)
Experience working in a production environment
Strong analytical and problem-solving skills, especially in researching claims
Proficiency in MS Office Suite applications: Excel, Word, OneNote
Ability to work independently and as a team
QNXT or Facets claims processing experience preferred
Experience in Medicaid or Medicare claims preferred
Encounters experience preferred
Edifecs system knowledge preferred
High School Diploma

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility