Claims Adjudication 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 Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing members and providers with high quality claim adjudication. May handle customer service inquiries and problems. Required Qualifications Applicant must have at least 2 years of experience in the following areas: Proficient in basic computer operations and software applications Experience working in a production-driven environment. Demonstrated ability to handle multiple assignments efficiently, accurately and efficiently. Strong oral and written communication abilities. Preferred Qualifications Applies medical necessity guidelines, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process. Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures. Identifies and reports possible claim overpayments, underpayments and any other irregularities. Performs claim rework calculations. Ensures accurate and timely claims processing. Familiarity with medical terminology. Hands on experience in end-to-end medical claims processing. Education High School Diploma or GED equivalent. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $28.46 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. 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 our comprehensive and competitive mix of pay and benefits
investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan .
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/08/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing members and providers with high quality claim adjudication. May handle customer service inquiries and problems. Required Qualifications Applicant must have at least 2 years of experience in the following areas: Proficient in basic computer operations and software applications Experience working in a production-driven environment. Demonstrated ability to handle multiple assignments efficiently, accurately and efficiently. Strong oral and written communication abilities. Preferred Qualifications Applies medical necessity guidelines, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process. Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures. Identifies and reports possible claim overpayments, underpayments and any other irregularities. Performs claim rework calculations. Ensures accurate and timely claims processing. Familiarity with medical terminology. Hands on experience in end-to-end medical claims processing. Education High School Diploma or GED equivalent. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $28.46 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. 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 our comprehensive and competitive mix of pay and benefits
investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan .
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/08/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.