Remote Claims Specialist - $35/Hour

Join our team as a Remote Claims Specialist and make a real difference! This is a fully remote opportunity offering flexibility and a competitive salary of $35 per hour. You'll play a vital role in reviewing, investigating, and resolving complex healthcare claims, ensuring accuracy and patient satisfaction. As a Subject Matter Expert, you'll leverage your skills to navigate Medicaid plans and contribute to a supportive and rewarding work environment.

What We Offer: Beyond a great pay rate, we provide comprehensive benefits including medical, dental, and vision coverage. You'll also have access to a 401(k) retirement plan, a Representative Stock Buy Plan, disaster insurance, short-term and long-term disability benefits, and various wellness programs, including tuition assistance and employee discounts. Generous paid time off (PTO), including vacation and holidays, ensures a healthy work-life balance. We are committed to employee well-being and compliance with all applicable state and company policies.

Responsibilities: As a Remote Claims Specialist, you will:

• Review, analyze, and resolve complex and sensitive healthcare claims according to state-driven guidelines.
• Develop proficiency with multiple Medicaid plans.
• Utilize claims handling experience to ensure accurate and timely claim processing.
• Manage multiple tasks with accuracy, efficiency, and attention to detail.
• Proficiently use computers, keyboard navigation, and MS Office Suite applications.

Qualifications:

• Minimum 2 years of clinical case handling experience (business, Medicaid, government healthcare, etc.).
• Experience working in a production environment.
• Strong analytical and problem-solving skills, particularly in areas like denied claims.
• Demonstrated ability to manage multiple tasks effectively.
• Proficiency with computers, keyboard navigation, and MS Office Suite.

Preferred Qualifications:

• Experience with QNXT claims processing systems.
• Experience with Edicts data.

Compensation: This pay range reflects the base hourly rate or base annual full-time compensation for positions within this job grade. The actual compensation will vary based on experience, education, location, and other factors. For detailed information on benefits, please visit jobs.CVSHealth.com/benefits.

COVID-19 Vaccination Requirement: CVS Health requires employees to be fully vaccinated against COVID-19, unless a medical, religious, or other legally recognized exception applies. You must have received at least one COVID-19 vaccine dose before your first day of work and provide proof of vaccination or apply for an exception within the first 10 days of employment. Specific state and role requirements may vary.

Ready to join our team? Apply today and help us build a healthier future!