Top 2382 Qualification specialist Jobs in Tennessee

Senior Claim Benefit Specialist - Remote
CVS Health —Tennessee
- $18.50 - $42.35 an hour
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Mentoring
- Health insurance
- Dental insurance
Post Summary Operations Specialist
FedEx Logistics —Memphis, TN
- $999.99 a day
- Full-time
- Microsoft Outlook
- Data analysis skills
- Research
- Paid training
DATA ANALYTICS SPECIALIST - 79774
Human Services —Nashville, TN
- $67,764 - $108,060 a year
- Full-time
- Remote
- Background check
- Computer Science
- Mid-level
8d
AIRS Solutions Specialist
Palo Alto Networks —Tennessee
- $222,000 - $304,500 a year
- Remote
- Azure
- 3 years
- AWS
14d
Regulatory Affairs Professional
Siemens Healthineers —Knoxville, TN
- $107,060 - $147,213 a year
- Full-time
- Bachelor of Science
- Writing skills
- Bachelor's degree
- Disability insurance
- Health insurance
Safety Specialist
Centrus Energy Corp. —Oak Ridge, TN
- $64,248 - $107,080 a year
- Full-time
- Background check
- 6 years
- Bachelor of Science
Clinical Talent Acquisition Specialist
Essential Anesthesia Management —Nashville, TN
- Full-time
- Remote
- Mid-level
- University
- Bachelor's degree
Reconciliation Specialist
Sarah Cannon Research Institute —Tennessee
- Full-time
- Remote
- Microsoft Excel
- Bachelor's degree
- QuickBooks
12d
Clinical Sleep Specialist - Nashville, TN or Atlanta, GA
Zoll Medical Corporation —Nashville, TN
- $105,000 - $120,000 a year
- Remote
- Nursing
- Up to 50% travel
- Hospital
Regulatory Affairs Specialist
Sarah Cannon Research Institute —Tennessee
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
QMS SPECIALIST III
TE Connectivity —Tullahoma, TN
- $92,900 - $116,100 a year
- 5 years
- Engineering
- Analysis skills
- Employee stock purchase plan
- Disability insurance
Specialist Lead, Government Client Contracts Management (Fed Health)
Deloitte —Hermitage, TN
- $84,300 - $155,400 a year
- Full-time
- Bachelor's degree
- Travel
- US work authorization
Credentialing Specialist
Kyo —Nashville, TN
- $27.88 - $31.25 an hour
- Remote
- Mid-level
- Children
- Ability to sit for extended periods
Quick Apply
Risk Program Delivery Professional
Humana —Tennessee
- $86,300 - $118,700 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Finance
- Paid parental leave
- Paid holidays
5d
IH&S Professional
BWX Technologies —Jonesborough, TN
- $86,450 - $136,000 a year
- Pass drug screening
- Mid-level
- Master's degree
- Health insurance
- Dental insurance
Quality & Compliance Specialist
FedEx Logistics —Memphis, TN
- Full-time
- Mid-level
- 3 years
- High school diploma or GED
5d
Sr Specialist-Communications
FedEx Freight —Memphis, TN
- Full-time
- Marketing
- Research
- Mid-level
Corrective Action Specialist
X energy LLC —Oak Ridge, TN
- $115,000 - $140,000 a year
- Full-time
- Mid-level
- Office
- Bachelor's degree
- Disability insurance
- Health insurance
9d
Sr Compliance Specialist
Shearwater Health —Nashville, TN
- Full-time
- Remote
- Bachelor of Science
- Analysis skills
- Bachelor's degree
Quick Apply
CT/X-Ray Imaging Specialist
HH Health System-Lincoln —Fayetteville, TN
- Full-time
- Background check
- CPR Certification
- Anatomy knowledge
- Health insurance
- Dental insurance
Quick Apply

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qualification specialist jobs near tennessee

Senior Claim Benefit Specialist - Remote

CVS Health -
Tennessee

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

qualification specialist jobs in tennessee

Senior Claim Benefit Specialist - Remote

Post Summary Operations Specialist

DATA ANALYTICS SPECIALIST - 79774

AIRS Solutions Specialist

Regulatory Affairs Professional

Safety Specialist

Clinical Talent Acquisition Specialist

Reconciliation Specialist

Clinical Sleep Specialist - Nashville, TN or Atlanta, GA

Regulatory Affairs Specialist

QMS SPECIALIST III

Specialist Lead, Government Client Contracts Management (Fed Health)

Credentialing Specialist

Risk Program Delivery Professional

IH&S Professional

Quality & Compliance Specialist

Sr Specialist-Communications

Corrective Action Specialist

Sr Compliance Specialist

CT/X-Ray Imaging Specialist

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