claim benefit specialist

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

Voya Financial

<div>Together we fight for everyone&rsquo;s opportunity for a better financial future.
We will do this together &mdash; with customers, partners and colleagues. We will fight for others, not against: We will stand up for and champion everyone&rsquo;s access to opportunities. The status quo is not good enough &hellip; we believe every individual and every community deserves access to financial opportunities. We are determined to support both individuals and communities in reaching a better financial future. We know that reaching this future depends on our actions today.
Like our Purpose Statement, Voya believes in being bold and committed to action. We are committed to a work environment where the differences that we are born with &mdash; and those we acquire throughout our lives &mdash; are understood, valued and intentionally pursued. We believe that our employees own our culture and have a responsibility to foster an environment where we all feel comfortable bringing our whole selves to work. Purposefully bringing our differences together to positively influence our culture, serve our clients and enrich our communities is essential to our vision.
Are you ready to join a company with a strong purpose and a winning culture? Start your Voyage &ndash; Apply Now
Get to Know the Opportunity:
As a Claims Specialist you will guide claimants through their leave experience with empathy and clarity. You will be responsible for administering Short Term Disability claims according to policy and plan provisions as well as administering Family Medical Leave (FMLA) and other leaves, including state, military, and company-specific leaves. You will ensure a high standard of customer service while maintaining compliance with all regulatory requirements.
The Contributions You&rsquo;ll Make:
Claims Administration &amp; Case Management<ul><li>
Analyze FMLA, company leave policies and short-term disability benefits to determine eligibility</li><li>
Manage end-to-end claim experience for the life of the claim</li><li>
Evaluate medical documentation to ensure eligibility for benefits</li><li>
Utilize clinical and vocational resources to assist with claim management strategies</li><li>
Build and maintain strong relationships with internal and external stakeholders</li><li>
Manage assigned work queues within defined service level agreements (SLAs)</li><li>
Document in a clear and concise manner to support claim decisions and articulate ongoing case management activities</li></ul>
Communication &amp; Customer Service<ul><li>
Communicate clearly and professionally via phone and in written correspondence</li><li>
Clearly explain claim decisions and entitled benefits in a professional manner displaying a high degree of empathy</li><li>
Communicate with medical providers to obtain necessary medical documentation to assist with claim adjudication</li></ul>
Knowledge &amp; Experience:<ul><li>
1-2 years of experience in STD, FMLA or unpaid leave claims management</li><li>
Strong decision-making and critical thinking skills</li><li>
Medical/vocational management</li><li>
Excellent customer service and interpersonal abilities</li><li>
Proficiency in Microsoft Office 365, including Outlook</li><li>
Exceptional written and verbal communication skills</li><li>
High attention to detail and accuracy</li><li>
Ability to prioritize tasks and manage time effectively in a fast-paced environment</li><li>
Collaborative mindset with the ability to work cross-functionally</li></ul>
#LI-IB1
#Remote
Compensation Pay Disclosure:
Voya is committed to pay that&rsquo;s fair and equitable, which means comparable pay for comparable roles and responsibilities.
The below annual base salary range reflects the expected hiring range(s) for this position in the location(s) listed. In addition to base salary, Voya offers incentive opportunities (i.e., annual cash incentives, sales incentives, and/or long-term incentives) based on the role to reward the achievement of annual performance objectives. Please note that this salary information is solely for candidates hired to perform work within one of these locations, and refers to the amount Voya Financial is willing to pay at the time of this posting.
Actual compensation offered may vary from the posted salary range based upon the candidate&rsquo;s geographic location, work experience, education, licensure requirements and/or skill level and will be finalized at the time of offer. Salaries for part-time roles will be prorated based upon the agreed upon number of hours to be regularly worked.
$44,820 - $56,030 USD
Be Well. Stay Well.
Voya provides the resources that can make a difference in your lives. To us, this means thriving physically, financially, socially and emotionally. Voya benefits are designed to help you do just that. That&rsquo;s why we offer an array of plans, programs, tools and resources with one goal in mind: To help you and your family be well and stay well.
What We Offer<ul><li>
Health, dental, vision and life insurance plans</li><li>
401(k) Savings plan &ndash; with generous company matching contributions (up to 6%)</li><li>
Voya Retirement Plan &ndash; employer paid cash balance retirement plan (4%)</li><li>
Tuition reimbursement up to $5,250/year</li><li>
Paid time off &ndash; including 20 days paid time off, nine paid company holidays and a flexible Diversity Celebration Day.</li><li>
Paid volunteer time &mdash; 40 hours per calendar year</li></ul> 
Critical Skills
At Voya, we have identified the following critical skills which are key to success in our culture:
<ul><li>Customer Focused: Passionate drive to delight our customers and offer unique solutions that deliver on their expectations.</li><li>
Critical Thinking: Thoughtful process of analyzing data and problem solving data to reach a well-reasoned solution.</li><li>
Team Mentality: Partnering effectively to drive our culture and execute on our common goals.
</li><li>Business Acumen: Appreciation and understanding of the financial services industry in order to make sound business decisions.</li><li>
Learning Agility: Openness to new ways of thinking and acquiring new skills to retain a competitive advantage.</li></ul> 
Equal Employment Opportunity
Voya Financial is an equal-opportunity employer. Voya Financial provides equal opportunity to qualified individuals regardless of race, color, sex, national origin, citizenship status, religion, age, disability, veteran status, creed, marital status, sexual orientation, gender identity, genetic information, or any other status protected by state or local law.<div><div><div><div><div><div><div><div><div><div><div><div><div>
Reasonable Accommodations
Voya is committed to the inclusion of all qualified individuals. As part of this commitment, Voya will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please reference resources for applicants with disabilities.</div></div></div></div></div></div></div></div></div></div></div></div></div></div>

Claims Specialist – Leave & Disability July 2026

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

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

Search 9166+ Claim benefit specialist jobs near you this May. New roles added regularly across leading industries. Apply today.

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Member Benefit Preservation Specialist

Claims Specialist – Leave & Disability July 2026

Senior Claims Benefit Specialist - Checkwork/Refund

Senior Claims Benefit Specialist - Checkwork/Refund

Senior Claims Benefit Specialist - Checkwork/Refund

Senior Claims Benefit Specialist - Checkwork/Refund

Benefit Specialist