benefit specialist

CVS Health

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><p><b>
Position Summary</b></p><p>
Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems.</p><ul><li>
Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise.
</li><li>Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process.</li><li>
Performs claim re-work calculations.</li><li>
Follow through completion of claim overpayments, underpayments, and any other irregularities.</li><li>
Process complex non-routine Provider Refunds and Returned Checks.</li><li>
Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks.
</li><li>Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals.</li><li>
Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures.</li><li>
Review and handle relevant correspondences assigned to the team that may result in adjustment to claims.</li><li>
May provide job shadowing to lesser experience staff.</li><li>
Utilize all resource materials to manage job responsibilities.</li></ul><p><b><br>
Required Qualifications</b></p><ul><li>
2+ years medical claim processing experience.</li><li>
Experience in a production environment.</li><li>
Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.</li>
Effective communications, organizational, and interpersonal skills.<br>
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</li></ul><p><br>
<b>Preferred Qualifications</b></p><ul><li>
DG system claims processing experience.</li><li>
Associate degree preferred.</li></ul><p><b><br>
Education</b></p><ul><li>
High School Diploma or GED.</li></ul><p></p><p><b>
Anticipated Weekly Hours</b></p>
40<p></p><p><b>
Time Type</b></p>
Full time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$18.50 - $42.35<p></p><p>
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.</p><p><br>
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.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p><br>
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.<p><br>
Additional details about available benefits are provided during the application process and on Benefits Moments.</p><br>
We anticipate the application window for this opening will close on: 06/19/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Senior Claims Benefit Specialist

CareMed Specialty Pharmacy

<div><div><div><div><b>Are you someone looking for professional career growth? </b>CareMed Pharmacy is looking for <b>Pharmacy Benefit Verification Specialists</b> for our growing Pharmacy!</div>
<div></div><div><div><b>Work Hours: Monday-Friday shifts available; some weekends as needed. </b>This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.</div>
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<div></div><div><div><b>**Starting salary at $24.00/hr and up** </b>We also offer quarterly incentive bonuses.</div>
<div></div><div><b>Sign-On Bonus: </b>$5,000 for employees starting before July 31, 2026.</div>
<div></div><div><div>We offer a variety of benefits including:</div>
<ul><li>Medical, Dental &amp; Vision insurance</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Paid Volunteer Day</li>
<li>Floating Holiday</li>
<li>Referral Incentive</li>
<li>Paid Life, and short &amp; long-term disability insurance</li>
</ul>
</div><div></div><div><div><div><b>Pharmacy </b><b>Benefit Verification </b><b>Specialist Summary:</b></div>
<div>The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs. They will ensure accurate benefit documentation is made for all prescription orders.</div>
<div></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Major Responsibilities:</b></div>
<ul><li>Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.</li>
<li>Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding benefit information.</li>
<li>Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.</li>
<li>Performs full benefits verification on patients for pharmacy benefits and/or medical benefit utilizing electronic resources and E1 check to load primary, secondary, tertiary, etc. insurances and medical insurances to patient profile.</li>
<li>Run test claims at each licensed pharmacy site to obtain a valid claim response and determine optimal reimbursement, then document outcome of benefits review in CPR+ system to be used by operations and ensure the order is assigned to the appropriate dispensing pharmacy.</li>
<li>Facilitate process for requesting medical authorizations, LOAs, and TOAs for applicable commercial, Medicaid, and Medicare, or facility medication claims.</li>
<li>Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws</li>
<li>Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.</li>
<li>Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li>
</ul></div><div><b>Pharmacy </b><b>Benefit Verification</b><b> Specialist Qualifications:</b></div>
</div><ul><li>Education/Learning Experience
<ul><li>Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification</li>
<li>Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience</li>
</ul></li><li>Work Experience
<ul><li>Required: 1+ years pharmacy or benefit verification experience</li>
<li>Desired: 3+ years pharmacy or benefit verification experience</li>
</ul></li><li>Skills/Knowledge:
<ul><li>Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.</li>
</ul></li><li>Behavior Competencies
<ul><li>Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skill</li>
</ul></li></ul><div>Here at CareMed, our patients are important to us, so we always strive to meet and exceed their needs. We are seeking <b>Pharmacy Benefit Verification Specialist</b>s who go above and beyond for our patients, and also passionate about helping others.</div></div></div></div></div>

Pharmacy Benefit Verification Specialist

Taylor Corporation

<div><p>Taylor Corporation is a dynamic, diversified company with big plans for the future ― and your career. We power our employees&rsquo; potential and strive to create opportunity and security for every member of the team. If you&rsquo;re ready for something bigger ― more challenge, more variety, more pathways for professional growth ― we should talk. We&rsquo;re passionate about our work, we believe there is always a better way, and we&rsquo;re looking for people like you.<br>
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Ready to reach your potential? It&rsquo;s time to look at Taylor.<br>
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<b>Your Opportunity:</b> Taylor Corporation is looking for a <b>Benefits Specialist</b> in MN! The Benefits Specialist supports the administration, design, communication, and continuous improvement of Taylor&rsquo;s health, welfare, and retirement programs. This individual contributor partners with Field HR, HRConnect, Finance, and external vendors to ensure benefits programs are competitive, compliant, and aligned with business and employee experience objectives.</p><p></p><p>
This role administers and maintains benefits programs while guiding employees on eligibility, coverage, and provisions. It ensures operational excellence across Open Enrollment, vendor coordination, compliance, reporting, and employee education, while maintaining accurate records and supporting informed decision making.</p><p><b><br>
Work Authorization:</b><br>
To be considered for the Taylor opportunities, candidates must be authorized to work in the United States without the need for employer sponsorship.<br>
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<b>Your Responsibilities:</b></p><p><i>
Open Enrollment &amp; Annual Cycle</i></p><ul><li>
Coordinate and execute Open Enrollment, including timelines, Workday setup, testing, and cross-functional alignment</li><li>
Support implementation of new benefit programs including vendor coordination and communication planning</li><li>
Contribute to benefits guide development ensuring accuracy and clarity</li><li>
Deliver employee education sessions, webinars, and benefit literacy training</li><li>
Track engagement, plan movement, ROI, and partner with Field HR to drive participation</li><li>
Support decision support tools setup and testing</li></ul><p><i>
Vendor &amp; Carrier Management</i></p><ul><li>
Manage vendor relationships and lead recurring meetings to review performance and resolve issues</li><li>
Oversee billing processes and escalated employee concerns</li><li>
Coordinate with consultants and carriers to ensure timely follow-up</li><li>
Support renewal and implementation activities</li></ul><p><i>
Compliance, Audits &amp; Reporting</i></p><ul><li>
Administer audits including dependent eligibility and reconciliation audits</li><li>
Support retirement plan compliance, filings, and audit processes</li><li>
Prepare documentation for fiduciary governance meetings</li><li>
Monitor cost-related reporting and maintain accurate records</li></ul><p><i>
Employee Education &amp; Communication</i></p><ul><li>
Coordinate and support employee and vendor-led webinars</li><li>
Develop and maintain benefits communication materials</li><li>
Support benefits marketing and engagement initiatives</li></ul><p></p><p><b>
Capabilities &amp; Skills</b></p><ul><li>
Strong knowledge of health, welfare, and retirement programs</li><li>
Ability to manage vendor relationships and stakeholders</li><li>
Workday or HRIS proficiency</li><li>
Strong analytical and problem-solving skills</li><li>
Clear communication and presentation skills</li><li>
Ability to manage multiple priorities</li></ul><p><b><br>
You Must Have:</b></p><ul><li>
Bachelor&rsquo;s degree in Human Resources, Business, or related field (or equivalent experience)</li><li>
3+ years experience administering employee benefits programs</li><li>
Experience maintaining benefits records and reporting</li></ul><p><b><br>
We Would Also Prefer:</b></p><ul><li>
Experience with vendor management, compliance, and Open Enrollment</li></ul><p><b>
Success Measures:</b></p><ul><li>
Accurate and timely Open Enrollment Execution</li><li>
Vendor performance and SLA adherence</li><li>
Employee engagement and participation</li><li>
Compliance and audit accuracy</li><li>
HR and employee readiness and satisfaction</li></ul><p></p><p>
The anticipated annual salary range for this position is $75k - $90k. The actual base salary offered depends on a variety of factors, which may include as applicable, the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. The range listed is just one component of Taylor Corporation&rsquo;s total compensation and benefits package for employees.<br>
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<b>About Taylor Corporation</b><br>
One of the largest print and communications firms in North America, Taylor&rsquo;s family of companies provides a diverse set of products, services and technologies that address the toughest business challenges. We work diligently each day to create printed and digital marketing communication solutions that help power many of the world&rsquo;s most recognizable brands.<br>
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With more than 50 years of category expertise and 10,000 employees spanning dozens of U.S. states and multiple countries, Taylor serves businesses and distributors both large and small. Our employees enjoy a comprehensive benefit package including a choice of several health plans, dental, vision, wellness programs, life and disability coverage, flexible spending accounts, health savings accounts, a 401(k) plan with company match, paid time off (PTO) and 64 hours of annual holiday pay.<br>
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The Employer retains the right to change or assign other duties to this position.<br>
Taylor Corporation is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.</p><p></p><p>
Taylor Corporation including all partners and affiliates is an Equal Opportunity Employer/Veterans/Disabled.</p></div>

Benefits Specialist

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Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Senior Claims Benefit Specialist

Pharmacy Benefit Verification Specialist

Benefits Specialist