Claim Benefit Specialist OPS at CVS Health in Pittsburgh, PA

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

Processing Medicare claims on the HRP-HealthEdge Platform

The Claim Benefit Specialist position is a production-based role servicing Medicare Advantage beneficiaries.

Additional responsibilities to include but not limited to the following:

• Reviews and adjudicates Medicare medical claims in accordance with CMS claim processing guidelines. Role requires strong keyboard skills, attention to detail and the ability to work independently in a production environment.
• Experience in a production based environment with an emphasis on quality outcomes.
• Medical Claim processing experience preferably supporting Medicare products.
• Strong computer navigational skills.
• Medical terminology and coding certification.

Note: Our CBS positions in Medicare are not limited to Front-End Claims. These positions can support various Medicare workstreams as determined by business need. This can be either FE Claims, Specialty work or our Rework team.-

Required Qualifications

• 1 year Experience in a production environment
• Detailed and quality oriented
• Ability to research and work within several computer applications simultaneously
• Microsoft Outlook

Preferred Qualifications

• Claim processing experience
• Computer Navigation Proficiency
• Production & Quality background
• Microsoft Office tools

Education

High School Diploma or equivalent GED

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.

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 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: 08/21/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.