Medical Claims Reviewer- Franklin, TN.
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Medical Reviewer plays a key role in supporting accurate and timely claim outcomes by managing all processes related to medical and policy history. This position involves reviewing health records, claims, and related documentation to ensure alignment with policy requirements and regulatory standards. The Medical Reviewer also coordinates with internal teams to provide guidance on benefit coverage and supports decision-making for claims within pre-existing and contestability periods.
Requirements
- 1+ year of experience in administrative, customer service, healthcare support, claims processing, or other detail-oriented work involving document review and data accuracy.
- Experience using Microsoft Office applications (Outlook, Word, and Excel) to enter, review, and maintain accurate information.
Nice To Haves
- Experience in healthcare, insurance, medical claims, or medical records.
- Strong analytical and problem-solving skills with the ability to compare information and identify discrepancies.
- Strong organizational skills with the ability to manage multiple tasks and meet deadlines.
Responsibilities
- Manage and review medical and policy history to support claim and policy decisions.
- Review multiple health records, medical histories, claims, correspondence images, and bills from policyholders, agents, and providers.
- Compare bills to application information, policy requirements, and state regulations.
- Adhere to company and team processes to ensure timely and accurate policy and claim decisions.
- Coordinate with the Ancillary Claims processing and Audit Quality teams.
- Provide documentation and advisement on benefit coverage for services within policy pre-existing and contestability periods.
Benefits
- medical coverage
- dental coverage
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
