Claims Administrator-Hybrid Franklin, TN.
About The Position
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.
Requirements
- 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.
Nice To Haves
- Knowledge of medical terminology and insurance claim processes.
- Experience in customer service or call center environment.
- Familiarity with HIPAA regulations and compliance standards.
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.
Benefits
- 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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
