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CVS Health · 15 hours ago

Claims Administrator-Hybrid Franklin, TN.

Franklin, TN

Full-time

Hybrid

Entry Level

$17/hr - $28.46/hr

1+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Claims Administrator is responsible for routing claims to the appropriate team functions and ensuring accurate claim distribution while supporting operational efficiency.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

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

Qualification

Claims administrationClaims processing systemsMicrosoft Office SuiteMedical terminologyHIPAA complianceCommunication skillsDetail-orientedOrganizational skillsProblem-solving skills

Required

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

Preferred

Knowledge of medical terminology and insurance claim processes

Experience in customer service or call center environment

Familiarity with HIPAA regulations and compliance standards

Benefits

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