Claim Benefit Specialist- Franklin, TN.

CVS Health • Franklin, TN

5d • $17 - $28 • Onsite

About The Position

Fast, accurate claims payment is one of the ways we make a difference in people's lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it's most needed.

Requirements

• 1+ years of experience working in a production environment.
• 1+ years demonstrated ability to use Microsoft Office applications (Outlook, Word, Excel) and learn new software systems with minimal supervision.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Ability to review information, identify basic issues, and recommend solutions to support day-to-day operations.

Nice To Haves

• 2+ years of experience claim processing.
• Understanding of medical terminology.
• Strong knowledge of benefit plans, policies, and procedures.

Responsibilities

• Analyze and process routine claims that cannot be auto-adjudicated.
• Apply medical necessity and coverage guidelines to support accurate claim decisions.
• Verify member eligibility and identify discrepancies affecting claim processing.
• Utilize cost-containment measures and claim adjudication tools to ensure accurate outcomes.
• Respond to routine claim-related phone inquiries and written correspondence.
• Route complex claims and issues to senior team members for resolution.
• Review claims and referrals for compliance with applicable guidelines, coding requirements, and member/provider information.
• Validate procedure, diagnosis, and pre-coding requirements to support accurate claim processing.
• Manage assigned claims, queues, and correspondence within established turnaround time standards.
• Process electronic correspondence using designated claims systems and workflows.
• Utilize claims processing tools, including Claim Check, reasonable and customary data, and other post-containment resources.
• Maintain accuracy, quality, and productivity standards while meeting service-level expectations.
• Provide training and guidance to team members when serving as a subject matter expert.

Benefits

• medical coverage
• dental coverage
• vision coverage
• paid time off
• retirement savings options
• wellness programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED