How to hire a claims benefit specialist

How to hire a claims benefit specialist, step by step

Here's a step-by-step claims benefit specialist hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a claims benefit specialist job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new claims benefit specialist
• Step 8: Go through the hiring process checklist

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1. Identify your hiring needs

   Before you post your claims benefit specialist job, you should take the time to determine what type of worker your business needs. While certain jobs definitely require a full-time employee, it's sometimes better to find a claims benefit specialist for hire on a part-time basis or as a contractor.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

   Yes

   No

   You should also consider the ideal background you'd like them a claims benefit specialist to have before you start to hire. For example, what industry or field would you like them to have experience in, what level of seniority or education does the job require, and how much it'll cost to hire a claims benefit specialist that fits the bill.

   This list presents claims benefit specialist salaries for various positions.

   Type of Claims Benefit Specialist	Description	Hourly rate
   Claims Benefit Specialist	Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much... Show more	$15-32
   Adjuster	An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud... Show more	$16-32
   Appraiser	An appraiser is someone who assesses the monetary value of a property such as an automobile, real property, and personal claim. His/Her or her responsibilities include resolving disparities between a property's monetary values and preparing narrative reports for projects... Show more	$13-28

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Customer Inquiries
   • Appeals
   • Medical Terminology
   • Routine Claims
   • CPT
   • Processing Issues
   • Data Entry
   • Outbound Calls
   • Claim Adjudication Process
   • Medicaid
   • Medicare Advantage
   • Medical Insurance Claims
   • ACAS
   • Production Standards

   Check all skills

   Responsibilities:

   • Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
   • Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
   • Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
   • Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
   • Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
   • Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.

3. Make a budget

   Including a salary range in your claims benefit specialist job description is one of the best ways to attract top talent. A claims benefit specialist can vary based on:

   • Location. For example, claims benefit specialists' average salary in utah is 56% less than in new jersey.
   • Seniority. Entry-level claims benefit specialists 53% less than senior-level claims benefit specialists.
   • Certifications. A claims benefit specialist with certifications usually earns a higher salary.
   • Company. Working for an established firm or a new start-up company can make a big difference in a claims benefit specialist's salary.

   Average claims benefit specialist salary

   $47,292yearly

   $22.74 hourly rate

   ---

   Entry-level claims benefit specialist salary

   $32,000 yearly salary

   Updated January 29, 2026

4. Writing a claims benefit specialist job description

   A job description for a claims benefit specialist role includes a summary of the job's main responsibilities, required skills, and preferred background experience. Including a salary range can also go a long way in attracting more candidates to apply, and showing the first name of the hiring manager can also make applicants more comfortable. As an example, here's a claims benefit specialist job description:

   Claims benefit specialist job description example

   Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems.
   Pay Range
   
   The typical pay range for this role is:
   
   Minimum: 18.50
   
   Maximum: 33.65
   
   Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
   
   Required Qualifications
   
   - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.- Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.- Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.- Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff.- Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration.
   
   COVID Requirements
   
   COVID-19 Vaccination Requirement
   
   CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
   
   You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
   
   Preferred Qualifications
   
   - 2+ years claim processing experience. - Experience in a production environment.- Claim processing experience.- Demonstrated ability to handle multiple assignments competently, accurately and efficiently
   
   Education
   
   - Associates degree or equivalent work experience.
   
   Business Overview
   
   Bring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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5. Post your job

   To find the right claims benefit specialist for your business, consider trying out a few different recruiting strategies:

   • Consider internal talent. One of the most important sources of talent for any company is its existing workforce.
   • Ask for referrals. Reach out to friends, family members, and current employees and ask if they know or have worked with claims benefit specialists they would recommend.
   • Recruit at local colleges. Attend job fairs at local colleges to recruit claims benefit specialists who meet your education requirements.
   • Social media platforms. LinkedIn, Facebook and Twitter now have more than 3.5 billion users, and you can use social media to reach potential job candidates.

   Post your job online:

   • Post your claims benefit specialist job on Zippia to find and recruit claims benefit specialist candidates who meet your exact specifications.
   • Use field-specific websites.
   • Post a job on free websites.

6. Interview candidates

   Recruiting claims benefit specialists requires you to bring your A-game to the interview process. The first interview should introduce the company and the role to the candidate as much as they present their background experience and reasons for applying for the job. During later interviews, you can go into more detail about the technical details of the job and ask behavioral questions to gauge how they'd fit into your current company culture.

   It's also good to ask about candidates' unique skills and talents to see if they match your ideal candidate profile. If you think a candidate is good enough for the next step, you can move on to the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new claims benefit specialist

   Once you've decided on a perfect claims benefit specialist candidate, it's time to write an offer letter. In addition to salary, it should include benefits and perks available to the employee. Qualified candidates may be considered for other positions, so make sure your offer is competitive. Candidates may wish to negotiate. Once you've settled on the details, formalize your agreement with a contract.

   It's also good etiquette to follow up with applicants who don't get the job by sending them an email letting them know that the position has been filled.

   After that, you can create an onboarding schedule for a new claims benefit specialist. Human Resources and the hiring manager should complete Employee Action Forms. Human Resources should also ensure that onboarding paperwork is completed, including I-9s, benefits enrollment, federal and state tax forms, etc., and that new employee files are created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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