Health/Medical Claims Processor I

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.

Position Summary

Responsible for initial review and triage of claims tasked for review.

Determines coverage, verifies eligibility, identifies and redirects misdirects

Responsible for prepping the authorization in the system and triage cases to medical staff for review.

Organized and prioritizes work to meet regulatory and claim turn-around times

Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team.

Performs non-medical research and support

Adheres to Compliance with PM Policies and Regulatory Standards.

Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Assist in the research and resolution of claims payment issue

Required Qualifications

Effective communication, telephonic and organization skills.

Familiarity with basic medical terminology and concepts used in care .

Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.

Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word

Preferred Qualifications

2-4 years experience as a medical assistant, office assistant or claim processor

CEC/GPS, or MedCompass

Education

High School Diploma or G.E.D

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$18.50 - $38.82

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 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.

We anticipate the application window for this opening will close on: 10/31/2026

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

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