Medical Social Worker 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. 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 potential overpayments, underpayments, and other claim irregularities. - Performs claim rework calculations as needed. - Trains and mentors as needed to enhance team performance and technical proficiency. - Conducts outbound calls to obtain required information for claims or reconsideration requests. Required Qualifications - Minimum of 18 months of medical claim processing experience with a health insurance payor or third‑party administrator. - Proven

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. Company: Oak Street Health Title: Lead Clinical Informatics Specialist Location: 394 Broadway Suite #100 Passaic, NJ 07055 Role Description: Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated care right in our patients' communities, we can help keep them healthy and reinvest cost savings in further care for those same communities and others. Since 2013, Oak Street Health has brought its singular approach to tens of thousands of people across the nation. With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oak Street values and are passionate about our mission to rebuild healthcare as it should be. For more information, visit www.oakstreethealth.com. Role Description: The Lead Clinic Informatics Specialist is a critical member of the Scribe Program. They champion the organization's mission to provide high quality patient care by leading their Clinic Scribe team. The Lead Clinic Scribe acts as an in-clinic expert on all Scribe related matters including: training,

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. Title: Supervisor, Sales Excellence Location: remote Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated care right in our patients' communities, we can help keep them healthy and reinvest cost savings in further care for those same communities and others. Since 2013, Oak Street Health has brought its singular approach to tens of thousands of people across the nation. With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oak Street values and are passionate about our mission to rebuild healthcare as it should be. Role Description: The Supervisor will assist as the Outreach Call Center continues to grow and further expand its role in the centralized outreach process. The primary responsibility of this role is co-leading the daily operations of the call center ensuring the call center exceeds the KPI goals set by the company. Core Responsibilities: *Monitor and evaluate Agent perfor

The pay range per hour is $23.25- $24.25. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT THE STORES EXECUTIVE LEADERSHIP Experience firsthand what it’s like to lead a retail team within a Target store. This internship is a paid 40 hr /week, hands-on training program to develop and prepare you for store leadership. As a Stores Executive Intern, you will get a valuable realistic preview of the Executive

The pay range is $58,100.00 - $104,600.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . Marketing Associate – Frequency Marketing As a Marketing Associate , you will play an important role in bringing Target’s marketing strategies to life

The pay range per hour is $20.82 - $37.45. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . Target Global Supply

The pay range per hour is $20.82 - $37.45. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . Target Global Supply Chain and Logis

The pay range is $64,000.00 - $128,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . ALL ABOUT GENERAL MERCHANDISE Experts of operations, process and efficiency who enable a consistent experience for our guests by ensuring product is

The pay range is $95,000.00 - $171,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . As

The starting pay range for this position per hour is $21.75 - $23.75. The full pay range for this position per hour is $21.75 - $37.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT FOOD & BEVERAGE The

The starting pay range for this position per hour is $25.00 - $27.00. The full pay range for this position per hour is $25.00 - $42.50 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT CLOSING The Closing team conti

The starting pay range for this position per hour is $25.00 - $27.00. The full pay range for this position per hour is $25.00 - $42.50 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT GENERAL MERCHANDISE E

The starting pay range for this position per hour is $22.25 - $24.25. The full pay range for this position per hour is $22.25 - $37.80 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT CLOSING The Closing team conti

The starting pay range for this position per hour is $22.25 - $24.25. The full pay range for this position per hour is $22.25 - $37.80 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT SPECIALTY SALES A team of spe

The starting pay range for this position per hour is $21.00 - $23.00. The full pay range for this position per hour is $21.00 - $35.70 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT CLOSING The Closing team conti