Claim Benefit Specialist Jobs

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. A Brief Overview Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. A Brief Overview Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements.

Claim Benefit Specialist — 52 Locations. Apply via Workday.

Claim Benefit Specialist — 51 Locations. Apply via Workday.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience. Additional Responsibilities - Reviews pre‑specified claims and those that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements cost‑containment measures to support accurate claim adjudication. - Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures. - Identifies and reports potenti

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review a

Job Title: Junior Revenue Cycle Management (RCM) Specialist Location: Remote - United States Employment Type: FT W2 Compensation: $35 per hour CareTalk Health is a virtual medical practice that specializes in Clinical Process Outsourcing (CPO). We partner with healthcare organizations to build and manage patient and member populations. About the Role We’re looking for a Junior RCM Specialist to support the full revenue cycle — from billing and credentialing through claims processing, payment posting, and accounts receivable follow-up. This is an ideal role for someone early in their medical billing or healthcare administration career who has a solid grasp of the insurance workflow and wants to grow in a fast-paced virtual care environment. The ideal candidate understands how claims move through the insurance lifecycle, has exposure to provider credentialing, and is comfortable managing accounts receivable. You’re organized, analytical, proactive, and at ease working across billing systems, payer portals, and cross-functional teams. Schedule: Monday - Friday Days What You’ll Do • Support claim submission to ensure timely, accurate billing • Monitor claim status and follow up on unpaid or denied claims • Assist with provider credentialing and payer enrollment, keeping documentation and records current • Manage accounts receivable, including aging follow-up, collections, and resolution of outstanding balances • Support denial mana

Paediatric Occupational Therapist Location: Essex Salary: £45,123 - £53,603 (including paid school holidays) + Excellent Benefits Contract: Permanent Hours: Full-time About the Role Our client’s School is a purpose-built school registered for 150 pupils aged 5-19 with autism. The school boasts exceptional facilities, including a large sports hall, bespoke sixth form suite, therapeutic spaces, and extensive outdoor areas. As part of a multi-disciplinary clinical team , you will support educational and residential colleagues to create therapeutic living and learning environments. Based on clinical assessment and formulation, you will offer individualised interventions and engagement to young people. Our client’s Occupational Therapists work collaboratively within schools and children’s homes, ensuring therapeutic support permeates every aspect of education, care, and support. You will also provide consultation, workshops, training, and guidance to staff teams. Key Responsibilities Deliver specialist OT interventions for pupils with autism and complex needs. Work as part of a multi-disciplinary team to support holistic care. Provide assessments, formulate treatment plans, and monitor progress. Offer training and guidance to educational and residential staff. Contribute to creating therapeutic environments across the school. About You HCPC registered Occupational Therapist. Experience working with children and young people with autism and complex needs. Strong communi

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data. Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. Develops tools, and provides coding supplements, tape specifications and error listing to clie

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. An overview of this role As a Benefits Analyst on GitLab's Total Rewards team, you'll support global benefits administration and take own

GitLab is the intelligent orchestration platform for DevSecOps. GitLab enables organizations to increase developer productivity, improve operational efficiency, reduce security and compliance risk, and accelerate digital transformation. More than 50 million registered users and more than 50% of the Fortune 100* trust GitLab to ship better, more secure software faster. The same principles built into our products are reflected in how our team works: we embrace AI as a core productivity multiplier, with all team members expected to incorporate AI into their daily workflows to drive efficiency, innovation, and impact. GitLab is where careers accelerate, innovation flourishes, and every voice is valued. Our high-performance culture is driven by our values and continuous knowledge exchange, enabling our team members to reach their full potential while collaborating with industry leaders to solve complex problems. Co-create the future with us as we build technology that transforms how the world develops software. * Fortune 500® is a registered trademark of Fortune Media IP Limited, used under license. Claim based on GitLab data. Fortune 100 refers to the top 20% ranked companies in the 2025 Fortune 500 list, published in June 2025. Fortune and Fortune Media IP Limited are not affiliated with, and do not endorse products or services of GitLab. An overview of this role As a Senior Benefits Analyst on GitLab's Total Rewards team, you'll help design, administer, and improve our glo

Job Title: Benefit Services Sales Manager Reports To: Practice Leader, SISCO Position Summary: As our Benefit Services Sales Manager, you’ll lead a high‑performing team that sells an integrated solution—SISCO(medical TPA), HealthCheck360 (wellness & advocacy), medical management, and BCC (HRIS/consolidated billing). Your charter: grow a sales team, build broker relationships coast‑to‑coast, win complex business and scale a connected platform that lowers claims cost, boosts engagement, and simplifies administration. You’ll hire, coach, and elevate sales executives, set strategy, and partner with executive leadership on product and marketing to accelerate new business and retention. Essential Functions: Supervise all sales executives, including setting activity metrics, holding regular sales meetings, and ensuring that the sales team has the necessary resources to succeed. Accompany sales executives on calls as necessary to close business. Train and develop new sales executives; implement formal development plans and ensure comprehensive training. Define sales territories to avoid overlap and inefficiency. Develop policies and procedures for handling incoming leads from national portals, conferences/events, and web-generated opportunities. Formulate strategies to increase penetration and engagement with top brokers in the US. Provide feedback to the Practice Leader on product and pricing requirements to remain competitive. Collaborate with the Practice Leade

Paediatric Occupational Therapist Salary: £43,424 – £51,209 (includes paid school holidays) + excellent benefits Location: Surrey Contract: Permanent Hours: Full-time About Our Client Our client is dedicated to creating therapeutic living and learning environments for children and young people with complex needs, including developmental trauma, neurodevelopmental conditions, and special educational needs. They believe in celebrating the small victories that make a big difference in young lives. As part of a multi-disciplinary clinical team, you will play a crucial role in supporting educational and residential colleagues to provide clinically informed environments and deliver individualised interventions based on thorough assessment and formulation. About the Role As an Occupational Therapist , you will: Conduct clinical assessments and deliver tailored interventions. Work collaboratively with educational and residential teams to embed therapeutic strategies. Provide consultation, training, and guidance to staff teams. Contribute to creating environments that promote positive outcomes for young people. This is an exciting opportunity to make a genuine difference while working in a supportive, resource-rich setting. What’s on Offer Competitive Salary: £43,424 – £51,209 (including paid school holidays). Training & Development: Full induction, ongoing CPD, and a leading clinical development programme. Generous Holidays: Full school holidays plus bank holidays. Flexibl

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary CVS Health is seeking a Senior Manager, Software Engineering to lead, grow, and develop high-performing engineering teams that design, build, and modernize mission-critical systems for our Claims Adjudication and Pharmacy Benefit Management (PBM) organization. This is a people-and-delivery leadership role, accountable for team performance, delivery execution, and engineering excellence. You will own technical direction for teams building scalable, reliable, cloud-native software while continuing to integrate with legacy platforms such as IBMi/AS400 and PBM adjudication systems like RxClaim. In this role, you will advance CVS Health's transition toward modern, AI-driven, cloud-native, microservices-based platforms and open-source engineering practices — championing strong CI/CD, sound architecture, and the responsible adoption of AI and GenAI developer tools (such as GitHub Copilot) that

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: We are seeking a compassionate, customer-obsessed Customer Service Representative to care for our customers. Our customers include members of our benefit plans, employers that offer benefits, and doctors, hospitals, and other healthcare providers. In this role, you will create connections with our customers by helping with their benefits and claims to improve their health and well-being. You will be responsible for educating customers about their benefits and claims while resolving issues and directing them to helpful resources. This position requires adaptability and empathy, as you will be handling a variety of inquiries and ensuring customer satisfaction through kind and respectful interactions. As the face of our company, you will care for our customers by researching issues, documenting outcomes, resolving inquiries and delivering a high level of customer satisfaction. Your ability