Claim Benefit Specialist-Medical Reviewer, CVS Health

CVS Health

Location:
United States, Franklin

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

Performs claim documentation review, verifies policy coverage, assesses policy application validity, communicates with healthcare providers, policyholders and beneficiaries to ensure accurate and timely handling of the medical review process. Contributes to the efficient and accurate handling of medical and final expense claims for reimbursement through knowledge of medical records reviews, team processes, and effective communication skills.

Job Responsibility:

Orders, handles and reviews medical records for contestable claims
Determines the eligibility and coverage of benefits for each policy
Documents claim with medical records information in the system
Conducts reviews and investigations of claims that require additional scrutiny
Communicates with healthcare providers, patients, or other stakeholders
Determines if claims processing activities comply with regulatory requirements
Provides regular, timely feedback to frontline claims analysts

Requirements:

HS Diploma or equivalent
Knowledge of MS word and excel
Strong analytical and decision-making skills

Nice to have:

1-2 years' experience reviewing medical records
Medical coding knowledge

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
October 29, 2025

Expiration:
November 10, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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Claim Benefit Specialist-Medical Reviewer