Claim Benefit Specialist- Franklin, TN.

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable 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

Fastaccurateclaimspaymentisoneofthewayswemakeadifferencein andemployergroupsprovidingafriendlyandknowledgeablevoiceatthe otherendofthephoneattimeswhenitsmostneeded.

• 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.

Required Qualifications

• 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.

Preferred Qualifications

• 2 years of experience claim processing.

• Understanding of medical terminology.

• Strong knowledge of benefit plans policies and procedures.

Education

• HighSchoolorGEDequivalent.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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