Claims Administrator-Hybrid Franklin, TN.

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Claims Administrator is responsible for routing claims to the appropriate team functions and ensuring accurate claim distribution while supporting operational efficiency.

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

• 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
• Knowledge of medical terminology and insurance claim processes
• Experience in customer service or call center environment
• Familiarity with HIPAA regulations and compliance standards

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access

Company Overview