Medical Claims Reviewer, CVS Health

Medical Claims Reviewer

CVS Health

Location:
United States, Franklin, Tennessee

Category:
Customer Service

Contract Type:
Not provided

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Manage and review medical and policy history to support claim and policy decisions
Review multiple health records, medical histories, claims, correspondence images, and bills from policyholders, agents, and providers
Compare bills to application information, policy requirements, and state regulations
Adhere to company and team processes to ensure timely and accurate policy and claim decisions
Coordinate with the Ancillary Claims processing and Audit Quality teams
Provide documentation and advisement on benefit coverage for services within policy pre-existing and contestability periods

Requirements:

Less than 1 year work experience
Working knowledge of problem solving and decision making skills

Nice to have:

Previous medical claims and or healthcare experience

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including 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:
August 06, 2025

Expiration:
August 18, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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