Job Closed
This listing is no longer active.
Bringing our heart to every moment of your health.
Claim Benefit Specialist
Location
Texas
Posted
17 days ago
Salary
$17 - $28 / hour
Seniority
Senior
Job Description
Claim Benefit Specialist
CVS Health
• Attendance during the 21 week training period is required. • Determine and understand the coverage provided under a member's health plan • Efficiently use multiple systems and screens to obtain and record claim information • Review claims information to determine the nature of a member's illness or injury • Identify claim cost management opportunities and refer claims for follow up • Make claim payment decisions • Process claims accurately to enhance customer satisfaction and retention • Process claims within quality and production standards • Assist team members in support of achieving team, office, regional, and national goals
Job Requirements
- Experience in a quality and production environment.
- Attention to detail.
- Ability to use multiple computer applications at one time.
- Claim processing experience.
- Ability to multi-task
- Ability to work independently or as part of a group
- Associate’s Degree
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
Related Guides
Related Categories
Related Job Pages
More IT Support Jobs
• Identify and list business problems (subdomains) based on scenarios and requirements. • Structure these problems into relevant business subdomains. • Define the Target (TO-BE) architecture that addresses the business problems and meets the requirements. • Model interoperability between functionalities, showing how the different system components communicate and exchange information. • Apply DDD tactical patterns in the design of microservices and other system components.
• Own day-to-day IT infrastructure operations across on-prem and cloud environments • Ensure high availability, performance, resiliency, and recoverability of critical systems • Lead incident response, root cause analysis, and continuous operational improvement • Oversee Windows Server, Active Directory, Microsoft 365, and identity infrastructure • Ensure secure configurations, access controls, and identity governance • Manage Azure Environments, including GCC and GCC High • Oversee server virtualization platforms supporting enterprise workloads • Ensure reliable operation of both Linux and Windows server environments • Partner with Information Security to implement secure architectures and compliance controls • Oversee Cisco-based enterprise network infrastructure • Ensure network reliability, performance, and capacity planning • Drive coordination for upgrades, maintenance, and vendor support • Lead infrastructure upgrades, patching, and technology lifecycle management • Reduce technical debt and improve system resilience and operational efficiency • Lead and develop the IT infrastructure and operations team • Drive accountability, execution, and operational excellence • Coach team members and foster a culture of reliability and ownership
Director, Help Desk Center of Excellence
CampusWorks, Inc.Transforming colleges and universities so students, faculty, and staff thrive. #EmployerOfChoice
• Lead the day-to-day operations of the centralized Help Desk COE supporting multiple managed services clients within a 24x7x365 operational support environment. • Ensure consistent delivery of Tier 1 support services across all supported institutions and customers. • Oversee intake, triage, escalation, and communication workflows for incidents, service requests, and operational support needs. • Ensure incidents and requests requiring advanced technical expertise are properly escalated to the appropriate higher-tier technical resources, operational support teams, or PMO processes as appropriate. • Monitor and manage support queues, call volumes, ticket flow, response times, service levels, staffing coverage, and after-hours operational support processes. • Develop staffing models, scheduling strategies, and workforce management practices to support continuous 24x7x365 operational coverage. • Act as a leadership escalation point for urgent, high-impact, or complex customer support situations. • Establish operational standards, procedures, workflows, and service delivery expectations. • Develop and maintain reporting dashboards, operational metrics, KPIs, and service performance measurements. • Drive operational maturity and process improvement initiatives aligned with ITSM and industry best practices. • Partner with leadership to support operational planning, growth strategies, and service scalability initiatives.
Federal Healthcare Audit Manager
Integrity Management Services, Inc.Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review. At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!
Role Description IntegrityM is seeking an experienced Audit Manager to lead and oversee complex healthcare program audits in support of federal oversight initiatives. This full-time leadership role is responsible for managing audit engagements, supervising professional staff, ensuring compliance with government auditing standards, and delivering high-quality audit reports to support program integrity objectives. The ideal candidate brings strong experience in healthcare auditing, deep knowledge of federal health program requirements, and demonstrated success managing audit teams in a regulated environment. Key Responsibilities - Lead and manage multiple audit engagements from planning through reporting and follow-up. - Develop audit work plans, risk assessments, and testing methodologies. - Ensure compliance with applicable federal regulations, program guidance, and Government Auditing Standards (GAGAS). - Supervise, mentor, and evaluate audit staff. - Review workpapers, findings, and reports for accuracy, quality, and adherence to standards. - Communicate audit results and recommendations to senior leadership and external stakeholders. - Identify emerging risks and recommend process improvements. - Support continuous enhancement of audit methodologies and internal quality controls. Qualifications - Minimum of three (3) years of management experience in the auditing field. - Demonstrated knowledge of federal healthcare programs, related regulations, manuals, coverage and payment rules, and Government Auditing Standards (GAGAS). - Experience auditing managed care or health plan organizations preferred. Requirements - Bachelor’s degree in accounting or equivalent from an accredited institution required. - Master’s degree preferred. - Current Certified Public Accountant (CPA) license preferred. Core Competencies - Strong leadership and team management skills. - Advanced knowledge of audit principles, risk assessment, and internal controls. - Excellent analytical, organizational, and problem-solving abilities. - Strong written and verbal communication skills. - Ability to manage competing priorities in a deadline-driven environment.



