Claim Benefit Specialist

CVS Health

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

Posted 11/2/2026full-timeUnited 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 strong analytical skills for resolving complex claim issues. Proficient in managing multiple priorities while ensuring accuracy and compliance in a fast-paced environment.

Highest-signal resume keywords

Medical Claims ProcessingHealthcare BillingAnalytical SkillsMicrosoft Excel ProficiencyAttention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ProcessingHealthcare BillingRevenue Cycle OperationsData AnalysisMedical TerminologyInsurance BenefitsClaims ResolutionCompliance KnowledgeProblem-SolvingResearch Skills

Soft Skills

Organizational SkillsTime ManagementAdaptabilityCollaborationAttention to Detail

Tools & Technologies

Microsoft ExcelComputer Systems

Industry Keywords

HealthcareInsuranceClaims ProcessingCustomer ServiceHealthcare Operations

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 provide root cause analysis and precise resolution of 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 generated by 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