Paper Claims Processor - Work From Home

CVS Health; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

CVS Health is seeking experienced Claims Processors to join their Claims Department. The role involves accurate adjudication of paper claims, ensuring compliance with regulations, and meeting productivity standards. Ideal candidates will have medical industry experience and proficiency in Microsoft Office.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling programs

Flexible work schedules and paid time off

Qualifications

• 1+ year of medical industry experience preferred.
• 1+ year of experience with Microsoft Office (Word, Excel, Outlook).

Responsibilities

• Processing and adjudicating commercial paper claims.
• Maintaining integrity of claims receipts according to procedures.
• Resolving pending claims using regulations and health plan criteria.

Skills

Medical industry experience

Microsoft Word

Microsoft Excel

Microsoft Outlook

Strong typing skills

Organizational skills

Education

High School Diploma or GED

Job description

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

CVS Health is looking for experienced Claims Processors to join our fast-paced Claims Department. As a Claims Processor, you will be responsible for accurate and efficient adjudication of paper claims from electronic image in a production environment. Commercial Paper Claims processes an average of 74,000 claims monthly, and provides service to multiple employer and health plans.

Primary Responsibilities of the Claims Processor include:

• Processing and adjudicating commercial paper claims.
• Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.
• Accurately resolving pending claims using state and federal regulations and specific health plan criteria.
• Working within turnaround times to meet client performance guarantees for claims processing.
• Meeting productivity and accuracy standards.
• Making outreach to pharmacies by phone to request information that may be missing in a submission

Required Qualifications

• 1+ year of medical industry experience (medical claims experience preferred and or dental claims experience will be considered)
• 1+ year of experience Microsoft Word, Excel and Outlook software

Preferred Qualifications

• Strong typing skills with speed and accuracy
• Team-oriented while also able to pursue personal and departmental production goals daily
• Ability to organize in a multi-demand and multi-priority environment
• Ability to work overtime as necessary

Education

• High School Diploma or GED required

Anticipated Weekly Hours

40

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

CVS Health is looking for experienced Claims Processors to join our fast-paced Claims Department. As a Claims Processor, you will be responsible for accurate and efficient adjudication of paper claims from electronic image in a production environment. Commercial Paper Claims processes an average of 74,000 claims monthly, and provides service to multiple employer and health plans.

Primary Responsibilities of the Claims Processor include:

• Processing and adjudicating commercial paper claims.
• Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.
• Accurately resolving pending claims using state and federal regulations and specific health plan criteria.
• Working within turnaround times to meet client performance guarantees for claims processing.
• Meeting productivity and accuracy standards.
• Making outreach to pharmacies by phone to request information that may be missing in a submission

Required Qualifications

• 1+ year of medical industry experience (medical claims experience preferred and or dental claims experience will be considered)
• 1+ year of experience Microsoft Word, Excel and Outlook software

Preferred Qualifications

• Previous PBM Experience
• Strong typing skills with speed and accuracy
• Team-oriented while also able to pursue personal and departmental production goals daily
• Ability to organize in a multi-demand and multi-priority environment
• Ability to work overtime as necessary

Education

• High School Diploma or GED required

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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

We anticipate the application window for this opening will close on: 05/27/2025

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

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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