Claim Benefit Specialist- Franklin, TN.

4062 Aetna Resources, LLC; United States; Presencial; USD 23.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Descripción de la vacante

CVS Health is seeking a full-time Benefits Claims Processor to review and process medical claims, verify coverage, and ensure timely reimbursements. You will determine eligibility, confirm coding accuracy, and communicate with providers and patients to resolve discrepancies.

This role emphasizes adherence to policies, data integrity, and continuous improvement in the claims process. The position requires 1+ year in customer service, strong problem solving, and the ability to handle multiple

Formación

• 1+ year working experience in a customer service environment.
• Working knowledge of problem solving and decision making skills.

Responsabilidades

• Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy and adherence to policies.
• Determines eligibility and coverage based on patient plan and guidelines.
• Assesses claims for accuracy and compliance with coding, medical necessity, and documentation requirements.
• Documents claim information in the company system with codes and data elements for tracking and processing.
• Communicates with healthcare providers and patients to resolve discrepancies.
• Generates reports to identify trends and inform process improvements.

Conocimientos

Customer service

Problem solving

Decision making

Educación

High school diploma or equivalent

Descripción del empleo

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.

A Brief Overview

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

What you will do

Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims. Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies. Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development. Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.

Required Qualifications

• 1+ year working experience in a customer service environment
• Working knowledge of problem solving and decision making skills

Preferred Qualifications

• 1+ years of experience with medical claim processing.
• 1+ years of experience in a production environment.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Effective communication, organizational, and interpersonal skills.

Education

High school diploma or equivalent required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $17.00 - $28.46. The typical 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.

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. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

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.

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

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

We anticipate the application window for this opening will close on: 11/17/2026