Top 54 Claims specialist Jobs in Rhode Island

Senior Claim Benefit Specialist - Remote
CVS Health —Rhode Island
- $18.50 - $42.35 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Mentoring
- Health insurance
- Dental insurance
Case Specialist - GAU
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $53,400 - $72,000 a year
- Full-time
- Hybrid work
- Inventory management
- Data analysis skills
- HIPAA
- Loan repayment program
- Dental insurance
6d
Claims Advocate Specialist
First American Home Warranty —Rhode Island
- $20.34 - $27.12 an hour
- Full-time
- Remote
- Microsoft Word
- Microsoft Outlook
- Analysis skills
- Employee stock purchase plan
- Health insurance
Quick Apply
Third Party Specialist
Care New England Health System —Warwick, RI
- $19.05 - $32.75 an hour
- Full-time
- Word processing
- Mid-level
- High school diploma or GED
TPA Claims Specialist II
USI Holdings Corporation —Warwick, RI
- $57,000 - $77,000 a year
- 5 years
- High school diploma or GED
- Analysis skills
- Wellness program
- Health savings account
Insurance Benefit Specialist
Highbar Physical Therapy —Providence, RI
- From $20 an hour
- Full-time
- High school diploma or GED
- Entry level
- Wellness program
- Paid holidays
Quick Apply
Content Claims Specialist - Field - Level I
E-djuster USA Inc. —Rhode Island
- Full-time
- Hybrid work
- Background check
- Microsoft Outlook
- High school diploma or GED
- Paid parental leave
- Health savings account
Quick Apply
14d
Medicaid Rebate Analyst Services Specialist
Conduent State Healthcare, LLC —Rhode Island
- $30 an hour
- Email
- Remote
- Customer service
- Research
- Mid-level
- Paid training
- Paid holidays
Billing Specialist
Care New England Health System —Warwick, RI
- Full-time
- Word processing
- English
- Mid-level
Medical Billing Specialist
Accurate Billing Solutions LLC —Warwick, RI
- $25 - $27 an hour
- Part-time
- 5 years
- Office
- In-person
- Paid time off
- Flexible schedule
Quick Apply
Medical Billing Specialist
Comprehensive Community Action —Warwick, RI
- $21 - $25 an hour
- Full-time
- Spanish
- Microsoft Outlook
- Computer literacy
- Paid holidays
- Health insurance
Quick Apply
Certified Professional Coder, Special Investigations Unit (Aetna SIU)
CVS Health —Rhode Island
- $43,888 - $93,574 a year
- Full-time
- Remote
- Microsoft Excel
- Research
- Mid-level
- Health insurance
- Dental insurance
Medical Billing Professional Cardiology Denial Specialist
Brown University Health —Providence, RI
- $19.97 - $32.96 an hour
- 8 hour shift
- HIPAA
- Mid-level
- Office
Referral & Authorization Specialist
Care New England Health System —Warwick, RI
- Full-time
- Bilingual
- Customer service
- HIPAA
6d
Billing Specialist
Cumberland Dental Specialists —Cumberland, RI
- $23 - $26 an hour
- Full-time
- Dental office
- HIPAA
- Mid-level
- Health insurance
- 401(k)
Quick Apply
4d
Authorization Specialist/Biller
Care New England Health System —Warwick, RI
- Full-time
- English
- Research
- Mid-level
Insurance Authorization Specialist
Highbar Physical Therapy —Providence, RI
- From $20 an hour
- Full-time
- High school diploma or GED
- Front desk
- Outpatient
- Wellness program
- Paid holidays
Quick Apply
Program Service Specialist - Deviation Management
UL Solutions —Woonsocket, RI
- $64,100 - $68,000 a year
- Full-time
- Laboratory experience
- Office
- Bachelor's degree
- Health insurance
- Dental insurance
10d
Professional Biller II
Care New England Health System —Warwick, RI
- Full-time
- Mid-level
- 3 years
- Math
Health Science Specialist
US Veterans Health Administration —Providence, RI
- Temporary
- Background check
- Pass drug screening
- Mid-level
7d

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claims specialist jobs near rhode island

Senior Claim Benefit Specialist - Remote

CVS Health -
Rhode Island

Apply Now

Job Details

Full-time
$18.50 - $42.35 an hour

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

Refine Your Search

claims specialist jobs in rhode island

Senior Claim Benefit Specialist - Remote

Case Specialist - GAU

Claims Advocate Specialist

Third Party Specialist

TPA Claims Specialist II

Insurance Benefit Specialist

Content Claims Specialist - Field - Level I

Medicaid Rebate Analyst Services Specialist

Billing Specialist

Medical Billing Specialist

Medical Billing Specialist

Certified Professional Coder, Special Investigations Unit (Aetna SIU)

Medical Billing Professional Cardiology Denial Specialist

Referral & Authorization Specialist

Billing Specialist

Authorization Specialist/Biller

Insurance Authorization Specialist

Program Service Specialist - Deviation Management

Professional Biller II

Health Science Specialist

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