Top 258 Senior claim benefit specialist remote Jobs in Remote

Senior Claim Benefit Specialist - Remote
CVS Health —Washington, DC
- $18.50 - $42.35 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Mentoring
- Health insurance
- Dental insurance
13d
Medical Billing AR Specialist – Appeals & Out-of-Network Expert
Adelfi Medical Billing Solutions —Remote
- $65,000 - $70,000 a year
- Full-time
- Remote
- 5 years
- Writing skills
- Senior level
- Health insurance
Senior Individual Disability Claims Specialist (Remote)
Guardian Life Insurance Company —Pittsfield, MA
- $80,610 - $132,435 a year
- Email
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
Senior Claims Auditor - DRG
Cohere Health —Remote
- $74,000 - $90,000 a year
- Remote
- Nursing
- 6 years
- HIPAA
- Paid parental leave
- Health savings account
Quick Apply
Senior Insurance Collections Specialist
Guardian Recovery Network Holdings —Remote
- $50,000 - $65,000 a year
- Full-time
- Remote
- Bachelor of Science
- Research
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
Payment Accuracy Specialist 2
Cotiviti —Remote
- $29.00 - $34.25 an hour
- Full-time
- Remote
- Microsoft Outlook
- Computer literacy
- HIPAA
- Paid holidays
- Disability insurance
4d
Collections Specialist
YA Group —Remote
- Full-time
- Remote
- Mid-level
- Analysis skills
- Continuous improvement
- Parental leave
- 401(k) matching
Reimbursement Resource Specialist (contract)
Sanofi —Remote
- Contract
- Remote
- Microsoft Excel
- Writing skills
- HIPAA
Billing Specialist - Part Time
SouthLight Healthcare —Remote
- $18 an hour
- Part-time
- Remote
- Computer literacy
- Medical office experience
- Pass drug screening
- Loan forgiveness
Quick Apply
8d
Senior Specialist, Pharmacy Systems Operations - Remote
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Oracle
- Microsoft Outlook
- Mid-level
Senior Payer Relations Specialist
Adaptive Biotechnologies —Seattle, WA
- $80,200 - $120,400 a year
- Online Application
- Remote
- 5 years
- Research
- US work authorization
Claims Auditor, Managed Care (remote)
Cedars-Sinai —Los Angeles, CA
- $27.74 - $43.00 an hour
- 8 hour shift
- Remote
- Mid-level
- High school diploma or GED
- Bachelor's degree
- Health insurance
- Dental insurance
Senior Medical Coding Specialist (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,464 - $133,991 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Presentation skills
- 401(k)
Quick Apply
Lead, Community Support
Kickstarter.com —Remote
- $117,014 a year
- Remote
- 8 years
- Analysis skills
- Mentoring
- Health insurance
- Parental leave
Sr. Trial Attorney - Remote
CSAA Insurance Group —Walnut Creek, CA
- $152,010 - $168,900 a year
- Full-time
- Remote
- Writing skills
- Research
- Microsoft Office
- 401(k) matching
Clinical Documentation Integrity Specialist (Coder)
TGH Senior Center Powered by Greenbrook Medical —Remote
- $33 - $36 an hour
- Remote
- Anatomy knowledge
- Microsoft Excel
- Mid-level
- Dental insurance
- Paid time off
Senior Client Data Operations Specialist
Vida Health —Remote
- $80,000 - $100,000 a year
- Full-time
- Remote
- 5 years
- SQL
- Bachelor's degree
Claims Training Specialist
CorVel Corporation —Folsom, CA
- $77,960 - $120,368 a year
- Full-time
- Remote
- Classroom
- Computer literacy
- HIPAA
- Health savings account
- Disability insurance
Quick Apply
Case Manager, Reimbursement
United Biosource Corporation —Remote
- Full-time
- Remote
- 6 years
- Mid-level
- Bachelor's degree
- Wellness program
- Health savings account
Claims Specialist
CorVel Corporation —Charlotte, NC
- $52,999 - $85,473 a year
- Full-time
- Remote
- Computer literacy
- Mid-level
- Bachelor's degree
- Health savings account
- Disability insurance
Quick Apply

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Senior Claim Benefit Specialist - Remote

CVS Health -
Washington, DC

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Job Details

Full-time
$18.50 - $42.35 an hour
13 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

High school diploma or GED
Health insurance knowledge

Full Job Description

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 success working in a high‑volume, production‑driven environment.
Demonstrated ability to manage multiple assignments with accuracy, efficiency, and attention to detail.

Preferred Qualifications

Self-Funding experience
DG system knowledge

Education

High School Diploma required
Preferred Associates degree or equivalent work experience.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

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