Claims Processing Representative I

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:

• Maintaining integrity of claims receipts in accordance with
• Processing and adjudicating commercial paper claims.

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
Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
1+ year of claims experience (medical 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
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.