Claim Benefit Specialist

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 CVS Health is currently looking for a highly motivated candidate who can effectively and accurately review and rework sensitive, complex medical and hospital claims for our rework project department. They will work closely with other members of the Commercial Services Operations team providing root‑cause analysis and precise resolution of affected claims. The candidate is responsible for ensuring the rework project claims are resolved accurately, interfaces with appropriate areas, and is handled by the rework project due date. The candidate will serve as a medical/hospital claim processor for rework projects, compliance, and complex issues for a specific provider/network or large‑scale rework projects generated as a result of plan sponsor issues, release fallout and/or legal/regulatory/compliance concerns. Required Qualifications 1 year knowledge of Aetna claim and provider systems Experience in a Medical claims/billing background Will be responsible for performing a detailed analysis and reworking complex claim issues. This candidate should demonstrate a strong work ethic. Being efficient and flexible is essential to the position in order to meet critical turnaround objectives. Proficient in Excel experience Preferred Qualifications Working knowledge of ACAS claim system, Excel, and Word would be a plus Ability to analyze data Ability to work independently as well as part of the team, contributing to overall effectiveness of the team Able to successfully cope with the high demands of the job while effectively maintaining personal composure Initiative to improve personal performance as well as those of peers and team Education High School diploma or equivalent Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 – $31.30. 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. Benefits 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. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources, based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4062 Aetna Resources, LLC