Claims Processing Representative I
Job ID: #
Bring your heart to CVS Health Every 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.
US - Remote
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.
CVS Health is looking for experienced Claims Processors
to join our fast-paced Claims Department. As a Claims
Processor, you will be responsible for accurate and
efficient adjudication of paper claims from electronic image
in a production environment. Commercial Paper Claims
processes an average of 74,000 claims monthly, and
provides service to multiple employer and health plans.
Primary Responsibilities of the Claims Processor include:
– Processing and adjudicating commercial paper claims.
– Maintaining integrity of claims receipts in accordance with
standard claims operating and adjudication procedures.
– Accurately resolving pending claims using state and
federal regulations and specific health plan criteria.
– Working within turnaround times to meet client
performance guarantees for claims processing.
– Meeting productivity and accuracy standards.
– Making outreach to pharmacies by phone to request
information that may be missing in a submission
-1+ year of claims experience (medical or dental claims
experience will be considered)
-1+ year of experience Microsoft Word, Excel and Outlook
-Previous PBM Experience
– Strong typing skills with speed and accuracy
– Team-oriented while also able to pursue personal and
departmental production goals daily
– Ability to organize in a multi-demand and multi-priority
– Ability to work overtime as necessary
High School Diploma or GED required
The typical pay range for this role is:
$17.00 – $27.90
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
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.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.