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.

Position Summary

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.

• 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.

Required Qualifications

• 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.

Preferred Qualifications

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

Education

• High school diploma or equivalent; associate degree preferred.

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 12/02/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.