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Claim Benefit Specialist – CVS Health

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Position Summary


This work from home position is for candidates in the EST and CST times zones.


Pay, Training, and Shift:

  • Pay rate: $17.50 per hour
  • Training Schedule: 8 weeks ( NO PTO during training) 8:00am- 4:30pmEST
  • Shift Schedule: Once Training is complete 6am-9amEST start time and 8 hour shift.

Reviews and adjudicates routine Medicare claims on HRP system in accordance with claim processing guidelines. Claims adjudication results should meet/exceed production and quality standards in line with CMS and Aetna compliance and business requirements.

Analyzes and approves routine claims that cannot be auto adjudicated.
– Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
– Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
– May facilitate training when considered topic subject matter expert.
– In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).
– Utilizes all applicable system functions available ensuring accurate and timely claim processing

Note: Our CBS positions in Medicare are not limited to Front-End Claims. These positions can support various Medicare workstreams as determined by business need. This can be either FE Claims, Specialty work or our Rework team.-

Required Qualifications

Experience in a production environment
Detailed and quality oriented
Ability to research and work within several computer applications simultaneously
Microsoft Outlook

Preferred Qualifications
Claim processing experience
Computer Navigation Proficiency
Production & Quality background
Microsoft Office tools

High School or GED equivalent





Pay Range

The typical pay range for this role is:


$17.00 – $27.90