Senior Claim Data Specialist, Provider Claims

CVS Health

Senior Claim Data Specialist at CVS Health analyzing claims regarding disputes and provider inquiries. Responsible for submitting documents and performing education for providers as needed.

Posted 6/26/2026full-timeRemote • Florida • 🇺🇸 United StatesSenior💰 $19 - $35 per hourWebsite

About the role

Key responsibilities & impact

Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries
Determine whether any claim payment or denial issues are present
Submit the necessary documents to specific areas to ensure all is updated and corrected
Submit all projects and/or claims to be reprocessed
Perform education for providers, both internal and external, when required
Attend provider group meetings, as well as individual meetings, both internally and externally
Submit projects within Microsoft Excel as assigned
Perform other duties as needed

Requirements

What you’ll need

1-3 years of medical claims experience
1-3 years of intermediate Excel experience with demonstrated proficiency in formulas, pivot tables and vlookups
Must reside in Florida
Bilingual in English/Spanish (preferred)
2+ years of provider claims experience (preferred)
Certified Professional Coder (CPC) (preferred)
Knowledge of provider billing, particularly with professional and hospital claims (preferred)
Strong attention to detail
Excellent communication, collaboration, and relationship building skills
Self-motivated and ability to drive independent work
Strong writing and documentation skills

Benefits

Comp & perks

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical claims experienceintermediate Excelformulaspivot tablesvlookupsprovider claims experienceprovider billingprofessional claimshospital claims

Soft Skills

attention to detailcommunication skillscollaboration skillsrelationship buildingself-motivatedindependent workwriting skillsdocumentation skills

Certifications

Certified Professional Coder (CPC)