Claim Benefit Specialist

CVS Health

. Review and rework sensitive, complex medical and hospital claims for the rework project department.

Posted 9/15/2026full-timeRemote • Alabama • United StatesJunior💰 $17 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical claims processing and healthcare billing, with a strong focus on accuracy, compliance, and problem-solving. Proficient in analyzing complex claims issues and managing multiple priorities in a fast-paced environment.

Highest-signal resume keywords

Medical Claims ProcessingHealthcare BillingRoot Cause AnalysisMicrosoft Excel ProficiencyAttention to Detail

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Claims ProcessingHealthcare BillingRevenue Cycle OperationsData AnalysisProblem-SolvingMedical TerminologyInsurance BenefitsClaims ResolutionCompliance KnowledgeOrganizational Skills

Soft Skills

Analytical SkillsTime ManagementAdaptabilityCollaborationAttention to Detail

Tools & Technologies

Computer Systems

Industry Keywords

HealthcareInsuranceClaims ProcessingCustomer ServiceRegulatory Compliance

About the role

Key responsibilities & impact

Review and rework sensitive, complex medical and hospital claims for the rework project department.
Work closely with Commercial Services Operations team members to perform root cause analysis and precisely resolve affected claims.
Ensure rework project claims are resolved accurately and handled by the rework project due date.
Serve as a medical/hospital claim processor for rework projects, compliance, and complex issues.
Process claims for specific providers/networks or large-scale rework projects resulting from plan sponsor issues, release fallout, and legal, regulatory, or compliance concerns.
Interface with appropriate areas to resolve claims.

Requirements

What you’ll need

Minimum 1 year of experience in medical claims processing, healthcare billing, revenue cycle operations, or a related healthcare administrative role.
Strong analytical and problem-solving skills with the ability to research and resolve complex claim issues.
Proven ability to manage multiple priorities while meeting quality and turnaround time expectations.
Strong attention to detail and commitment to accuracy.
Proficiency in Microsoft Excel, including sorting, filtering, and basic data analysis.
Demonstrated ability to work effectively in a fast-paced environment while adapting to changing business needs.
High School diploma or equivalent
Experience working in healthcare, insurance, claims processing, medical billing, or customer service.
Knowledge of medical terminology, insurance benefits, or healthcare operations.
Experience using computer systems to research and resolve customer or claim-related issues.
Ability to work independently and collaboratively in a team environment.
Strong organizational and time management skills.
Demonstrated adaptability and willingness to learn new processes and systems.

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