Top 59 Senior claims 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
Senior Claims Representative - REMOTE
Ryder System —Providence, RI
- $75,000 - $80,000 a year
- Remote
- Management
- 5 years
- Bachelor's degree
- Disability insurance
- Health insurance
Senior Investigator - Rhode Island
UnitedHealthcare —Warwick, RI
- $60,200 - $107,400 a year
- Full-time
- Hybrid work
- Microsoft Word
- Up to 50% travel
- Pass drug screening
Senior Program Manager / Project Manager - Medicaid Claims
CVS Health —Rhode Island
- $106,605 - $284,280 a year
- Full-time
- Remote
- Bachelor's degree
- Mentoring
- Fair chance
- Health insurance
- Dental insurance
Senior Manager, Business Consulting - Payment Integrity Center of Excellence
CVS Health —Providence, RI
- $67,900 - $199,144 a year
- Full-time
- 5 years
- Analysis skills
- Presentation skills
- Health insurance
- Dental insurance
13d
Configuration Management Senior Analyst
CVS Health —Rhode Island
- $46,988 - $122,400 a year
- Full-time
- Remote
- Microsoft Outlook
- Word processing
- Mid-level
- Health insurance
- Dental insurance
6d
Senior Workers Compensation Claims Adjuster - CT, NH, VT, RI, MA
Gallagher Bassett —Providence, RI
- $66,000 - $94,500 a year
- Remote
- 5 years
- High school diploma or GED
- Analysis skills
Senior Manager, Global Benefits
Brightstar Lottery —Providence, RI
- $86,538 - $180,000 a year
- Hybrid work
- 7 years
- Analysis skills
- Bachelor's degree
- Disability insurance
- Dental insurance
Senior Data Visualization Analyst
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $93,600 - $140,400 a year
- Full-time
- Hybrid work
- Computer science
- Azure
- Computer Science
- Loan repayment program
- Dental insurance
Senior Manager, Client Business Analytics Consultant
CVS Health —Providence, RI
- $67,900 - $182,549 a year
- Full-time
- Remote
- 5 years
- SQL
- Project management
- Health insurance
- Dental insurance
2d
Senior Medical Economics Analyst
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $93,600 - $140,400 a year
- Full-time
- Hybrid work
- Office
- Master's degree
- SQL
- Loan repayment program
- Health insurance
Senior Manager, Medical Economics
CVS Health —Providence, RI
- $67,900 - $199,144 a year
- Full-time
- 5 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Healthcare Encounter Senior Analyst
CVS Health —Rhode Island
- $46,988 - $122,400 a year
- Full-time
- Remote
- Research
- Mid-level
- Office
- Health insurance
- Dental insurance
Senior Claims Consultant
Starkweather & Shepley Insurance Brokerage Inc. —East Providence, RI
- 5 years
- Bachelor's degree
- Experience equivalent to degree accepted
Quick Apply
Senior Hospital Contracting Strategist
Humana —Rhode Island
- $78,400 - $107,800 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- Master's degree
- Paid parental leave
- Paid holidays
21h
Sr. Manager, Pricing - Pharmacy Appeals
CVS Health —Rhode Island
- $67,900 - $182,549 a year
- Full-time
- Remote
- 7 years
- Microsoft Access
- Office
- Health insurance
- Dental insurance
Senior Analyst - Business Analytics
CVS Health —Rhode Island
- $46,988 - $122,400 a year
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
- Health insurance
- Dental insurance
8d
Promo and Coupon Planning, Senior Analyst
CVS Health —Woonsocket, RI
- $46,988 - $112,200 a year
- Full-time
- Microsoft Excel
- Customer service
- 5 years
- Health insurance
- Dental insurance
Senior Legal Counsel - Healthcare Contracting
CVS Health —Woonsocket, RI
- $175,100 - $334,750 a year
- Full-time
- HIPAA
- 8 years
- Bachelor's degree
- Health insurance
- Dental insurance
6d
Sr. Mgr, Business Analytics - Zinc
CVS Health —Woonsocket, RI
- $75,400 - $182,549 a year
- Full-time
- 5 years
- Microsoft Office
- SQL
- Health insurance
- Dental insurance

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senior claims jobs near rhode island

Senior Claim Benefit Specialist - Remote

CVS Health -
Rhode Island

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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

senior claims jobs in rhode island

Senior Claim Benefit Specialist - Remote

Senior Claims Representative - REMOTE

Senior Investigator - Rhode Island

Senior Program Manager / Project Manager - Medicaid Claims

Senior Manager, Business Consulting - Payment Integrity Center of Excellence

Configuration Management Senior Analyst

Senior Workers Compensation Claims Adjuster - CT, NH, VT, RI, MA

Senior Manager, Global Benefits

Senior Data Visualization Analyst

Senior Manager, Client Business Analytics Consultant

Senior Medical Economics Analyst

Senior Manager, Medical Economics

Healthcare Encounter Senior Analyst

Senior Claims Consultant

Senior Hospital Contracting Strategist

Sr. Manager, Pricing - Pharmacy Appeals

Senior Analyst - Business Analytics

Promo and Coupon Planning, Senior Analyst

Senior Legal Counsel - Healthcare Contracting

Sr. Mgr, Business Analytics - Zinc

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