Claims Administrator-Hybrid Franklin, TN. at CVS Health

Franklin, Tennessee, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

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
High school diploma or equivalent; associate degree preferred

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

Skills

Key technologies and capabilities for this role

claims administrationhealthcare operationsoutbound callsclaims processing systemsMicrosoft Office SuiteHIPAA complianceproblem-solving

Questions & Answers

Common questions about this position

What is the pay range for the Claims Administrator role?

The typical pay range for this role is $17.00 - $28.46 per hour. The actual base salary offer will depend on factors including experience, education, geography, and other relevant factors.

Is this a remote position or does it require office work?

This is a hybrid position based in Franklin, TN.

What skills are required for the Claims Administrator position?

Required skills include 1–2 years of experience in claims administration or related field, strong communication skills for outbound calls, detail-oriented organizational and problem-solving abilities, proficiency in claims processing systems and Microsoft Office Suite, and ability to work independently in a fast-paced environment.

What is the company culture like at CVS Health?

CVS Health fosters a workplace where every colleague feels valued and that they belong, with teams reflecting the customers, patients, members, and communities served, and emphasizes building a world of health with heart.

What makes a strong candidate for this Claims Administrator role?

Strong candidates will have 1–2 years of claims or healthcare operations experience, preferred knowledge of medical terminology, insurance processes, and HIPAA, plus an associate degree. Highlight proficiency in claims systems, communication for outbound calls, and ability to meet productivity metrics.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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