benefit specialist

Metropolitan Family Services

<div>Metropolitan Family Services (MFS) empowers families to learn, to earn, to heal, to thrive. Part mentor, part motivator, part advocate, since 1857, Metropolitan Family Services has been the engine of change that empowers families to reach their greatest potential and positively impact their communities. Are you looking to have an impact on more than just a company&rsquo;s bottom line? Then we&rsquo;d love to hear from you!

We are now hiring for a full-time Benefit Specialist at our Headquarters office in downtown Chicago! 


ESSENTIAL DUTIES AND RESPONSIBILITIES:
<ul><li>Support day-to-day administration of the agency&rsquo;s benefits programs, ensuring timely and accurate responses to employee inquiries in partnership with the Benefits team.</li>
<li>Identify trends, issues, or gaps in benefits administration and communicate recommendations or changes to improve processes and enhance the overall benefits offering.</li>
<li>Administer leave of absence programs, including FMLA, Short-Term Disability, and Parental Leave, by coordinating requests and tracking through the Prudential system.</li>
<li>Partner with managers and leadership to provide updates on employee leave statuses, timelines, and return-to-work expectations, ensuring clear communication and adherence to policies.</li>
<li>Process and audit benefit enrollments and qualifying life events within the UKG system to ensure accuracy and compliance.</li>
<li>Coordinate and deliver new hire benefits orientations, ensuring employees understand available programs and enrollment processes.</li>
<li>Provide administrative support for Open Enrollment, including system setup, employee communications, and enrollment processing.</li>
<li>Administer COBRA enrollments and eligibility tracking through designated third-party system, ensuring compliance with regulatory requirements.</li>
<li>Identify and resolve benefits carrier and file feed issues by coordinating with brokers, carriers, and third-party administrators.</li>
<li>Review, reconcile, and process benefits invoices across multiple vendors, identifying discrepancies and ensuring timely resolution and payment.</li>
</ul>
SALARY: The salary range for this position will be $50,000 - $60,000 annually. Pay will be given based on skill and experience level.

REQUIRED EDUCATION, CERTIFICATIONS, CREDENTIALS and/or EXPERIENCE:
<ul>
<li>Bachelor&rsquo;s degree in human resources, business or related field required.</li>
<li>2+ year&rsquo;s benefit administration experience.</li></ul> 


TRAVEL/MOBILITY REQUIREMENTS:
<ul>
<li>Driving not required</li>
</ul>
TRAVEL BETWEEN SITES:
<ul>
<li>Yes</li></ul> 


PHYSICAL REQUIREMENTS:

While performing the essential duties of this job, the employee is required to sit and stand for sustained periods of time, frequently talk, hear, use hands and fingers to feel, handle, and operate objects or controls, and occasionally stand, bend, stretch, stoop, kneel and crouch. The employee is required to have close visual acuity to perform an activity such as preparing and analyzing data and figures, transcribing, and viewing a computer terminal. 


Metropolitan Family Services puts our people first with a top-of-the-line benefits package. Find out more by clicking here!

Some highlights include:
<ul>
<li>Medical Coverage, Guardian Dental Coverage, and VSP Vision Coverage.</li>
<li>Metropolitan Family Services contributions of $2,000 to individual, and $4,000 to family, HSA accounts, pro-rated to your benefits start date.</li>
<li>FREE General Medicine and Behavioral Health Teladoc services provided to all team members.</li>
<li>Ascensus 401K plan services with a 4% employer match, vested at 100% on day one of eligibility.</li></ul> 


And so much more! Make sure you click here to see the full suite of benefits offered! 


MORE ABOUT US:

Metropolitan is Illinois' first comprehensive human services agency and reaches more than 122,970 individuals and families in Chicago, Evanston/Skokie, the southwest suburbs, and DuPage County with services promoting education, economic stability, emotional wellness, and empowerment.</div>

Benefit Specialist

RetireeFirst

<div><div>LaborFirst is the leader in Care Navigation and advocacy, dedicated to improving outcomes and satisfaction for group plan sponsors and their members. Founded in 2005, we partner with all major national health carriers to serve 450+ clients and over 375,000 Medical and Pharmacy lives across all 50 states. We deliver high-touch solutions that drive value while preserving benefits. RetireeFirst, a LaborFirst solution, provides end-to-end Retiree Benefits Management. In partnership with plan sponsors, brokers, and consultants, we design, implement, manage, and administer Medicare benefits, ensuring a seamless transition and continued support. HealthActive, our solution for self-insured health plans with actives and early retirees, combines one-on-one health advocacy with technology-driven insights to help members successfully navigate their healthcare journey. 
</div>
<div></div><div>Summary of Position:</div>
<div>Provide High Level Customer Service to all Participating Members. Reports to the Client Service Managers and the Client Service Director to assist with team responsibilities.</div>
<div></div>
<div>Duties &amp; Responsibilities:</div>
<div></div>
<ul><li> Fully versed in assisting members with any issues/concerns.</li></ul>
<ul><li> Assist Team Leads with Projects/Eligibility/Billing.</li></ul>
<ul><li> Answer member phone calls.</li></ul>
<ul><li> Handle member plan selections.</li></ul>
<ul><li> Attend Team/Division Meetings.</li></ul>
<ul><li> Able to handle most retiree calls with little to no support from management.</li></ul>
<ul><li> Fully versed in all our products, processes, and procedures.</li></ul><div>
Licensing &amp; Qualifications:</div>
<ul><li> High School Diploma or Equivalent</li></ul>
<div></div>
<div>Preferred Qualifications:</div>
<ul><li> Life and Health License</li></ul>
<ul><li> AHIP Training and Certificate</li></ul>
<ul><li> 1+ Year Customer Service Experience</li></ul><div> 
LaborFirst is committed to regulatory excellence and operational integrity. We have attained HITRUST r2 certification for our Box and Salesforce platforms and hold full URAC Core Accreditation. With headquarters in Mount Laurel, NJ, and our LaborFirst West facility in Scottsdale, AZ, our award-winning team and services have earned national recognition. We consistently achieve world-class Net Promoter Scores (NPS), have been named on the Philadelphia Business Journal&rsquo;s Best Places to Work list, and have received multiple industry accolades, including a 2024 and 2025 Gold Stevie Award for Front-Line Customer Service Team of the Year. Connect with us at LaborFirst.com.</div> 


Competitive salary

Comprehensive benefits package

401k contribution

Generous vacation time

Opportunity to grow

Fastest 50 Growing Companies in NJ

Must be excluded from OIG/SAM 


All qualified applicants will receive consideration for employment without regard to race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic characteristics, or disability unrelated to job performance.</div>

Ventegra Inc. A California Benefit Corporation

The Benefit Preservation Specialist is responsible for program solutions in order to extend the health benefits of members, including but not limited to, patient assistant program(s) for medication coverage, pharmaceutical coupon programs and ancillary claims adjudication. The Benefit Preservation Specialist also plays a key role in helping members maximize the value of their pharmacy benefits through the coordination and management of manufacturer copay card programs, patient assistance programs, and benefit preservation strategies. This individual acts as a liaison between members, providers, and internal departments to ensure financial resources are applied accurately and efficiently to support member access to medications.Schedule: This role follows a Pacific Standard Time (PST) schedule, regardless of the employee&rsquo;s physical location. Candidates may reside in other time zones but must be available to work one of the following schedules in PST hours:<ul><li>7:30 a.m. &ndash; 4:00 p.m. HST (Monday&ndash;Friday)</li><li>9:00 a.m. &ndash; 5:30 p.m. HST (Monday&ndash;Friday)</li><li>9:30 a.m. &ndash; 6:00 p.m. HST (Monday&ndash;Friday)</li></ul>Candidates must be able to work from 6:00am - 12:00pm HST for the first few weeks of training. Duties:<ul><li>Maintain database of existing coupons and patient assistant programs involved</li><li>Assess and identify appropriate program(s) for members based on needs</li><li>Coordinate programs between pharmacy, members and plans as needed</li><li>Effectively communicate between the Customer Care Department and Prior Authorization personnel for seamless and efficient member service</li><li>Ensure compliance with all applicable laws and regulations</li><li>Continually evaluates processes and training materials for effectiveness and efficiency of the programs</li><li>Perform QA analysis to ensure appropriate monetary values are being applied to both claim and benefit as applicable</li><li>Develop and document policy and procedures</li><li>Implement new plans to the program</li><li>Term plans as they unenroll from the program</li><li>Assist with member communication as needed when changes to plans are made (i.e. biosimilar conversions)</li><li>Maintain and correct member deductible and maximum out of pocket accumulators as relates to coupon programs</li><li>Assist in other projects as assigned by management</li></ul>Skills/Qualifications:<ul><li>Excellent communications skills (oral, written and interpersonal)</li><li>Analytic skills</li><li>Pharmacy Tech certified required</li><li>Demonstrated ability to work well in a team environment</li><li>Demonstrated ability to provide exceptional customer service</li></ul>Education and Experience:<ul><li>High school diploma or equivalent</li><li>2+ years of experience in pharmacy benefit management, healthcare administration, or a related field.</li><li>Knowledge of pharmacy claim adjudication processes and benefit plan design, a plus</li><li>Familiarity with manufacturer copay and patient assistance programs, a plus.</li></ul>About Ventegra: Ventegra is the premier, fully transparent Medical Benefits Manager (MBM) offering Pharmacy Services Administration products and services to help manage healthcare for businesses and consumers. Ventegra is committed to seeking innovative ways to channel our resources for a greater impact to improve the lives of others. Ventegra represents payors, providers, patients and government programs.Job Type: Full-timePay: From $18.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Health savings account</li><li>Life insurance</li><li>Paid time off</li><li>Professional development assistance</li><li>Retirement plan</li><li>Vision insurance</li></ul>Application Question(s):<ul><li>Are you able to work a schedule of 7:30am-4:00pm, 9:00am-5:30pm, or 9:30am-6:00pm Hawaii Standard Time?</li><li>Are you able to work a training schedule of 6:00am-12:00pm Hawaii Standard Time ?</li></ul>Experience:<ul><li>Pharmacy technician: 1 year (Preferred)</li><li>Pharmacy Benefit: 1 year (Required)</li></ul>License/Certification:<ul><li>Pharmacy Technician Certification (Preferred)</li></ul>Work Location: Remote

Member Benefit Preservation Specialist

CVS Health

<div>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.
Position Summary
Review and complete provider-solicited and unsolicited overpayment refunds and returned checks. Research, resolve, and adjudicate complex, sensitive, and/or specialized medical claims in accordance with claims-processing guidelines. Partner with key business functions, ensure accurate posting of overpayment refunds, reconcile discrepancies, and respond to internal and provider inquiries.
Key Responsibilities<ul><li>
Process complex, non-routine provider refunds and returned checks</li><li>
Review and interpret contract language to validate overpayments and allocate refund checks appropriately</li><li>
Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply cost-containment measures to support claim adjudication</li><li>
Ensure compliance requirements are met and that payments/refunds follow company practices and procedures</li><li>
Perform claim rework calculations and adjustments across all dollar amounts for unsolicited overpayment refunds</li><li>
Follow through to completion on medical claim overpayments, underpayments, and other irregularities</li><li>
Respond to telephone and/or written inquiries related to pre-approvals/pre-authorizations, reconsiderations, and appeals</li><li>
Review assigned claims data mining work that may result in claim adjustments and complete resulting adjustments as appropriate</li><li>
Process medical claim adjustments on customer service platforms using technical and claims-processing expertise</li><li>
Provide overpayment refund training, mentoring, and job shadowing support for less experienced colleagues, as assigned</li><li>
Use available resource materials and tools to manage job responsibilities.</li></ul>
Handle customer service inquiries and issues assigned 
 
Required Qualifications<ul><li>
3+ years of medical claims processing experience</li><li>
2+ years of hands-on claim adjustments/rework experience</li><li>
2+ years in a production environment (volume + accuracy expectations)</li><li>
Demonstrated experience researching and resolving claim issues end-to-end</li><li>
Ability to interpret and apply guidelines related to eligibility, coverage, and benefits</li><li>
High attention to detail</li></ul> 
Preferred Qualifications<ul><li>
Experience reviewing and researching overpayment refunds</li><li>
DG system claims processing experience</li><li>
Ability to manage multiple assignments accurately and efficiently</li><li>
Effective communication, organizational, and interpersonal skills</li><li>
Familiarity with overpayment recovery</li></ul> 
Education<ul><li>
Associate degree or equivalent experience.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $42.35
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 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: 05/15/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Senior Claims Benefit Specialist - Checkwork/Refund

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Benefit Specialist

Benefit Specialist

Member Benefit Preservation Specialist

Senior Claims Benefit Specialist - Checkwork/Refund

Senior Claims Benefit Specialist - Checkwork/Refund

Senior Claims Benefit Specialist - Checkwork/Refund

Senior Claims Benefit Specialist - Checkwork/Refund