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Cvs Claims Jobs (NOW HIRING)

CVS Health

Senior Claims Benefit Specialist

New York, NY · On-site

$18.50 - $42.35/hr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary The Senior Claims Benefit Specialist will review and adjust SF ( self-funded ), FI ...

CVS Health

Senior Claims Benefit Specialist

Homer, AK · On-site

$18.50 - $42.35/hr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary The Senior Claims Benefit Specialist will review and adjust SF ( self-funded ), FI ...

CVS Health

Manager, Claim Processing

New York, NY · On-site

$66K - $145K/yr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Reviews claims for completeness, accuracy, and adherence to company policies and procedures ...

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Cvs Claims information

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$30.5K

$64.6K

$90K

How much do cvs claims jobs pay per year?

As of Jun 30, 2026, the average yearly pay for cvs claims in the United States is $64,609.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,000.00 and $75,500.00 per year, depending on experience, location, and employer.

What are CVS claims?

CVS claims refer to the requests for reimbursement or payment that are processed by CVS Health, typically through its pharmacy benefit management (PBM) services. These claims are submitted by pharmacies or healthcare providers to CVS for prescription drugs or healthcare services provided to patients covered by insurance plans managed by CVS. The claims process involves verifying patient eligibility, ensuring medication coverage, and determining the amount to be paid by the insurer and the patient. Efficient claims processing is essential to ensure timely access to medications and accurate billing for both providers and patients.

What are some common challenges faced by professionals in CVS Claims roles, and how can they be addressed?

Professionals working in CVS Claims often encounter challenges such as managing high-volume workloads, navigating complex insurance policies, and ensuring timely and accurate processing of claims. These challenges can be addressed by developing strong organizational skills, staying updated on industry regulations, and utilizing claims management software efficiently. Regular communication with team members and cross-functional departments also helps to resolve discrepancies and streamline workflows, making the process smoother for both employees and clients.

What is the difference between Cvs Claims vs Pharmacy Technician?

AspectCvs ClaimsPharmacy Technician
Required CredentialsHigh school diploma, certification in claims processingHigh school diploma, pharmacy technician certification
Work EnvironmentInsurance companies, claims processing centersPharmacies, healthcare facilities
Industry UsageInsurance and healthcare billingPharmaceutical services and patient support
Common Search IntentClaims processing, insurance reimbursementMedication dispensing, patient assistance

While both roles involve healthcare and require knowledge of medical terminology, Cvs Claims primarily focuses on processing insurance claims and reimbursement, whereas Pharmacy Technicians assist pharmacists with medication preparation and patient service. Understanding these differences helps job seekers identify the right career path in the healthcare industry.

What are the key skills and qualifications needed to thrive as a CVS Claims Specialist, and why are they important?

To thrive as a CVS Claims Specialist, you need a solid understanding of insurance claims processing, attention to detail, and knowledge of healthcare regulations, typically supported by relevant education or experience in insurance or pharmacy benefit management. Familiarity with claims management software, pharmacy systems, and industry-standard coding (such as ICD-10 and CPT) is important. Strong analytical thinking, problem-solving abilities, and effective communication skills help in resolving claim issues and collaborating with team members. These skills ensure accurate claims processing, regulatory compliance, and high-quality service for clients and patients.
More about Cvs Claims jobs
What states have the most Cvs Claims jobs? States with the most job openings for Cvs Claims jobs include:
What job categories do people searching Cvs Claims jobs look for? The top searched job categories for Cvs Claims jobs are:
Cvs Claims jobs near you
Infographic showing various Cvs Claims job openings in the United States as of June 2026, with employment types broken down into 50% Full Time, 40% Part Time, and 10% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $64,609 per year, or $31.1 per hour.
Senior Manager, Claims Workforce Management, Meritain TPA

Senior Manager, Claims Workforce Management, Meritain TPA

CVS Health

Princeton, NJ • On-site, Remote

$67K - $199K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 18 days ago

Key responsibilities

  • Owns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.

  • Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.

  • Partners closely with senior leadership and cross-functional stakeholders to align workforce strategies with hiring plans, training timelines, and business priorities.

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,270 frontline employees who took The Breakroom Quiz

78th of 101 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

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 crossfunctional 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.

*The position may be remote or hybrid anywhere in the US depending on candidate location and commute to a hub location

What you will do

  • Owns end-to-end workforce management for Claims operations, including forecasting, capacity planning, staffing models, and resource optimization across multiple work areas.

  • Analyzes and interprets complex operational, volume, and productivity data to develop actionable workforce strategies that support claims performance, service levels, and financial targets.

  • Develops demand forecasts and staffing models using historical data, trend analysis, and scenario modeling; provides insights and recommendations to senior leadership.

  • Serves as the primary owner of staffing assumptions, workforce modeling, and capacity planning for Claims, ensuring alignment with operational strategy and business priorities.

  • Leverages workforce management tools, statistical models, and analytics to evaluate demand variability, staffing risk, and operational scenarios.

  • Partners closely with Claims leadership, Finance, HR, and Operational Excellence teams to align workforce strategies with hiring plans, training timelines, and productivity assumptions.

  • Establishes and maintains standardized WFM processes, documentation, and governance to ensure consistency, accuracy, and transparency across Claims operations.

  • Identifies opportunities for automation, process improvement, and efficiency initiatives to improve forecasting accuracy and workforce utilization.

  • Monitors performance metrics and operational outcomes to proactively identify risks, gaps, and opportunities related to staffing and capacity.

  • Provides guidance and subject matter expertise to leaders and stakeholders on workforce-related decisions, tradeoffs, and operational impacts.

  • 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.

  • Supports future scalability of the Claims WFM function, including the potential design and transition to a team-based model as business needs evolve.

Required Qualifications

  • Minimum 7 years of experience in workforce management, operational analytics, or related roles within healthcare, insurance, or complex operational environments

  • Demonstrated expertise in forecasting, capacity planning, and workforce modeling

  • Strong analytical and problem-solving skills with the ability to translate data into executive-level insights and recommendations

  • Proven ability to operate independently with a high level of ownership and accountability

  • Strong communication skills and experience influencing leaders without direct authority

  • Advanced proficiency with workforce management tools, reporting platforms, and data analysis techniques

  • Experience partnering with senior leadership on staffing strategy and operational planning

  • Experience designing or evolving workforce management operating models

  • Strong business acumen with the ability to balance service, quality, cost, and compliance considerations

Education

  • Bachelor's degree preferred or equivalent combination of relevant experience, training, and professional development

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'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 fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing 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.

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