claims adjuster

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 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.<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> 
Required Qualifications<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. 
<li>
</li></ul> 
Preferred Qualifications<ul><li>
DG system claims processing experience.</li><li>
Associate degree preferred.</li></ul> 
Education<ul><li>
High School Diploma or GED.</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: 06/19/2026
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

Spartan Law Group

We are seeking a Personal Injury Negotiator to manage and negotiate cases on behalf of injured clients. The ideal candidate should have at least 4 years of experience in personal injury and be able to secure fair and timely resolutions. This position plays a critical part in securing fair compensation for injured clients. Candidates should be proactive, empathetic, and capable of handling a high-volume caseload while working under the guidance of supervising attorney.Responsibilities:* Evaluate personal injury claims, review records, bills, accident reports, and liability evidence.* Properly review demand letters and settlement packages.* Communicate and negotiate directly with insurance adjusters to maximize client recovery.* Track case progress, follow up on outstanding pending task, and ensure timely responses.* Document all communication and maintain organized claim files.* Collaborate with attorneys, case managers, and clients.Job Type: Full-timePay: $70,000.00 - $100,000.00 per yearBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Personal Injury Negotiator

<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.<div>
Position Summary
Provides strategic ownership of Claims workforce management by leveraging deep analytical expertise to forecast demand, develop capacity and staffing models, and optimize workforce utilization. Serves as the primary subject matter expert for Claims Workforce Management (WFM), partnering closely with senior leadership and cross‑functional stakeholders to support operational decision-making, performance outcomes, and scalability. Leads workforce planning initiatives, drives process improvements, and delivers actionable insights to ensure claims operations are staffed efficiently, consistently, and in alignment with business objectives.<ul><li>The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location</li></ul>
What you will do<ul><li>
Owns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.</li><li>
Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.</li><li>
Develops demand forecasts and staffing models using historical data, trend analysis, and scenario modeling; provides insights and recommendations to senior leadership.</li><li>
Serves as the primary owner of staffing assumptions, workforce modeling, and capacity planning for Claims, ensuring alignment with operational strategy and business priorities.</li><li>
Leverages workforce management tools, statistical models, and analytics to evaluate demand variability, staffing risk, and operational scenarios.</li><li>
Partners closely with Claims leadership, Finance, HR, and Operational Excellence teams to align workforce strategies with hiring plans, training timelines, and productivity assumptions.</li><li>
Establishes and maintains standardized WFM processes, documentation, and governance to ensure consistency, accuracy, and transparency across Claims operations.</li><li>
Identifies opportunities for automation, process improvement, and efficiency initiatives to improve forecasting accuracy and workforce utilization.</li><li>
Monitors performance metrics and operational outcomes to proactively identify risks, gaps, and opportunities related to staffing and capacity.</li><li>
Provides guidance and subject matter expertise to leaders and stakeholders on workforce-related decisions, tradeoffs, and operational impacts.</li><li>
Owns ongoing monitoring of claims performance against performance guarantees and operational commitments; proactively identifies risk and drives workforce reprioritization or resource reallocation to protect SLA, compliance, and financial outcomes.</li><li>
Supports future scalability of the Claims WFM function, including the potential design and transition to a team-based model as business needs evolve.</li></ul>
Required Qualifications<ul><li>
Minimum 7 years of experience in workforce management, operational analytics, or related roles within healthcare, insurance, or complex operational environments</li><li>
Demonstrated expertise in forecasting, capacity planning, and workforce modeling</li><li>
Strong analytical and problem-solving skills with the ability to translate data into executive-level insights and recommendations</li><li>
Proven ability to operate independently with a high level of ownership and accountability</li><li>
Strong communication skills and experience influencing leaders without direct authority</li><li>
Advanced proficiency with workforce management tools, reporting platforms, and data analysis techniques</li><li>
Experience partnering with senior leadership on staffing strategy and operational planning</li><li>
Experience designing or evolving workforce management operating models</li><li>
Strong business acumen with the ability to balance service, quality, cost, and compliance considerations</li></ul>
Education<ul><li>
Bachelor&rsquo;s degree preferred or equivalent combination of relevant experience, training, and professional development</li></ul></div>
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00 
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. This position also includes an award target in the company&rsquo;s equity award program. 
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: 07/12/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Senior Manager, Claims Workforce Management, Meritain TPA

Walgreens

<div><ul><li>Models and delivers a distinctive and delightful customer experience.</li>
<li>Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service.</li>
<li>In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions.</li>
</ul>Customer Experience
<ul><li>Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer issues and answers questions to ensure a positive customer experience.</li>
<li>Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.).</li>
</ul>Operations
<ul><li>Provides customers with courteous, friendly, fast, and efficient service.</li>
<li>Recommends items for sale to customer and recommends trade-up and/or companion items.</li>
<li>Registers customer purchases on assigned cash register, collects cash and distributes change as requested; processes voids, returns, rain checks, refunds, and exchanges as needed. Takes customer to OTC aisle when possible to assist in locating products.</li>
<li>Keeps counters and shelves clean and well merchandised, takes inventory, and maintains records. Checks in and prices merchandise as required or as directed by store manager or communicated by the shift leader.</li>
<li>Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly, filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions. Assists pharmacists in scheduling and maintaining work flow.</li>
<li>Reports, immediately, prescription errors to pharmacist on duty and adheres to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. Reviews and complies with the Walgreen Co. Pharmacy Code of Conduct.</li>
<li>Strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription dispensing activities.</li>
<li>Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians.</li>
<li>Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager.</li>
<li>Assists and supports Pharmacy Department on inventory management activities, such as, ordering, unpacking, checking and storing shipment of pharmaceuticals. Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs.</li>
<li>Ensures compliance with state and local laws regarding regulated products (e.g., alcoholic beverages and tobacco products).</li>
<li>Constructs and maintains displays, including promotional, seasonal, super structures, and sale merchandise. Completes resets and revisions as directed.</li>
<li>Assists with separation of food items (e.g., raw foods from pre-cooked) and product placement as specified by policies/procedures (e.g., raw and frozen meats on bottom shelves). For consumable items, assists in stock rotation, using the first in, first out method and restock outs.</li>
<li>Has working knowledge of store systems and store equipment.</li>
<li>Provides customer service in the photo area, including digital passport photo service, poster print and creative machine, suggestive sell of promotional photo products.</li>
<li>Assumes web pick-up responsibilities (monitors orders in Picture Care Plus, fills orders (pick items), delivers orders to customers as they arrive at store).</li>
<li>Assists with exterior and interior maintenance by ensuring clean, neat, orderly store condition and appearance.</li>
<li>Complies with all company policies and procedures; maintains respectful relationships with coworkers.</li>
<li>Completes special assignments and other tasks as assigned.</li>
</ul>Training &amp; Personal Development
<ul><li>Earns and maintains PTCB certification through the designated PTCB training program and/or state required certification/registration.</li>
<li>Attends training and completes PPLs requested by Manager or assigned by corporate and acquires continuing education credits. Maintains knowledge and skill in healthcare and pharmacy, including latest news and developments.</li> 
</ul> 
 
Basic Qualifications
 
<ul><li>Must be fluent in reading, writing, and speaking English. (Except in Puerto Rico)</li>
<li>Requires willingness to work flexible schedule, including evenings and weekend hours.</li> 
</ul> 
 
Preferred Qualifications
 
<ul><li>Prefer six months of experience in a retail environment.</li>
<li>Prefer to have prior work experience with Walgreens.</li>
<li>Prefer good math skills so they can fill prescriptions accurately, including counting, measuring and weighing medications.</li>
<li>Prefer good computer skills.</li>
<li>Prefer the knowledge of store inventory control.</li>
<li>Prefer PTCB certification.</li>
</ul>We will consider employment of qualified applicants with arrest and conviction records.
 
 
An Equal Opportunity Employer, including disability/veterans.
 
 
The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
 
Salary Range: $16 - $18 / Hourly</div>
 <div><h2 class="jobSectionHeader">Benefits</h2>
<ul><li><h3 class="jobSectionHeader">Health, dental and vision*</h3></li>
<li><h3 class="jobSectionHeader">Prescription coverage</h3></li>
<li><h3 class="jobSectionHeader">Retirement Savings Plan (401(k))</h3></li>
<li><h3 class="jobSectionHeader">Employee discount</h3></li>
<li><h3 class="jobSectionHeader">Work &amp; life resources</h3></li>
<li><h3 class="jobSectionHeader">Career development programs</h3></li>
</ul><ul><li>with a 30-hour work week</li></ul></div>

Pharmacy Customer Service Associate

Explore 4+ Claims adjuster in Atlanta this July. Find roles across top companies and apply now to boost your career.

4 claims adjuster jobs In Atlanta

Senior Claims Benefit Specialist

Personal Injury Negotiator

Senior Manager, Claims Workforce Management, Meritain TPA

Pharmacy Customer Service Associate