Senior Claim Benefit Specialist – Remote

Join CVS Health as a Senior Claim Benefit Specialist in Concord, Merrimack County, where your attention to detail directly supports a simpler, more compassionate health care experience for the people who count on us every day.

About the Role

As a Senior Claim Benefit Specialist with CVS Health, you will take ownership of complex claim review and benefit administration within a full-time role based in Concord, Merrimack County. This is a senior-level position suited to professionals who combine analytical precision with a service-first mindset, working alongside colleagues who care deeply about quality, accountability, and doing right by every member.

Key Responsibilities

• Review, adjudicate, and process insurance claims accurately and in line with plan provisions, policy terms, and regulatory standards.
• Interpret benefit details to determine appropriate coverage and resolve higher-complexity or escalated claim scenarios.
• Investigate discrepancies, correct errors, and ensure each claim is handled with consistency and integrity.
• Partner with internal teams and members to clarify benefit questions and deliver timely, clear resolutions.
• Document decisions thoroughly and contribute to continuous improvement in claim handling workflows.

Qualifications

• Demonstrated experience in claims processing, benefit administration, or a closely related function within health care or insurance.
• Strong working knowledge of claim adjudication principles, benefit structures, and applicable compliance requirements.
• Excellent analytical and problem-solving skills, with the accuracy needed to manage complex caseloads.
• Effective written and verbal communication abilities for collaborating across teams and supporting members.
• Comfort working independently while meeting productivity and quality targets in a full-time capacity.

About CVS Health

At CVS Health, we are building a world of health around every individual — shaping a more connected, convenient, and caring experience. Our teams innovate with purpose, hold themselves accountable, and place safety and quality at the center of everything we do. Choosing a Senior Claim Benefit Specialist career here means becoming part of a mission to make health care simpler, one person at a time.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.

Apply for the Senior Claim Benefit Specialist role at CVS Health