Claim Field Specialist (Central Florida)

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 The Claim Field Specialist acts as the primary resource for groups and providers, within a specific geographic location, to establish, oversee, and maintain a proactive claim education program focused on assisting providers with claim denials, claim education, and claim resolution. This person analyzes claim denials to track and trend potential opportunities, in order to assist in training and education of participating and non-participating providers. Additionally, they will assist in creating bulletins, newsletters, and claim trainings to improve provider claims issues, as well as billing practices, while collaborating with internal and/or external departments to identify claim training and education opportunities. This person will develop, implement, support, and promote provider training strategies, tactics, policies, and programs that drive provider satisfaction specific to claim submission and payments. The Claim Field Specialist works with the grievance and appeal department to trend provider claim disputes and appeals that could be prevented with additional provider claim education. They also work with the provider engagement team to collaborate on provider education when additional detailed claim education is needed. The Claim Field Specialist meets regularly, both in person and virtually, with assigned providers to conduct trainings and educations, review claim trends, and ensure understanding of Aetna Medicaid claim and billing policies and procedures. This person is expected to spend 70% of their time meeting with providers in-person, as well as conducting occasional telephonic or virtual provider meetings as needed. The Claim Field Specialist responds to assigned provider claim questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams. Other duties as assigned. Required Qualifications 2+ years of experience in medical billing and coding, specifically related to claims processing and root cause analysis. 2+ years of experience with provider engagement and/or relations. Working proficiency of Microsoft Office products (Word, Excel, PowerPoint, Outlook). Advanced experience in Microsoft Excel for data mining. Must reside in Central Florida, specifically Orlando (Region E - Brevard, Orange, Osceola, Seminole). Willingness to travel 70% of time within Central Florida and will work remotely the remaining 30% of the time. Willingness to work Monday-Friday from 9am-6pm EST, with the flexibility to work beyond core hours as needed. Preferred Qualifications Excellent verbal and written communication skills. Regular and reliable attendance. Associate's or Bachelor's degrees. Certified Professional Coder (CPC) certification. Education High school diploma or GED. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $102,000.00 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 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. We anticipate the application window for this opening will close on: 11/12/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health