Claims Administrator, 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:

The Claims Administrator is responsible for routing claims to the appropriate team functions based on complexity and requirements. This role ensures accurate claim distribution and supports operational efficiency by conducting outbound calls to gather missing or insufficient information. The position is critical to maintaining timely and compliant claim processing.

Job Responsibility:

Route claims to the correct team or department for resolution based on established guidelines
Make outbound calls to members, or other stakeholders to obtain missing claim details
Review and analyze claims for completeness and accuracy before routing or processing
Document all updates and interactions in the claims management system in compliance with company standards
Collaborate with internal teams to resolve discrepancies and ensure timely adjudication
Maintain confidentiality and adhere to HIPAA and organizational compliance requirements
Meet or exceed productivity and quality metrics for claim routing and outbound calls

Requirements:

1–2 years of experience in claims administration, healthcare operations, or a related field
Strong communication skills with the ability to handle outbound calls professionally
Detail-oriented with excellent organizational and problem-solving skills
Proficiency in claims processing systems and Microsoft Office Suite
Ability to work independently and manage multiple priorities in a fast-paced environment
High school diploma or equivalent
associate degree preferred

Nice to have:

Knowledge of medical terminology and insurance claim processes
Experience in customer service or call center environment
Familiarity with HIPAA regulations and compliance standards

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
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:
November 20, 2025

Expiration:
December 02, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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Claims Administrator