Senior Claim Data Specialist, Provider Claims (Must reside in Florida)

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 ourselves accountable 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

• 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, particularly those that may affect utilization management, enrollment, claims, configuration, network, contracting and/or provider data. 
• Submit the necessary documents (if issues are identified) to specific areas, in an effort to ensure all is updated and corrected. 
• Submit all projects and/or claims to be reprocessed, in order to ensure provider contracts are implemented effectively, as well as to avoid any further ongoing issues. 
• 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.

Required Qualifications

• 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.

Preferred Qualifications

• Bilingual in English/Spanish.
• 2+ years of provider claims experience.
• Certified Professional Coder (CPC).
• Knowledge of provider billing, particularly with professional and hospital claims.
• Strong attention to detail.
• Excellent communication, collaboration, and relationship building skills.
• Self-motivated and ability to drive independent work.
• Strong writing and documentation skills.

Education

• High school diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $35.29

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: 07/09/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.