Claims Processing - Representative I

Job DescriptionThe Rep I Claims Processing supports CVS Health's medical claims engine (Novologix) through a call center environment. The position is responsible for contact via email, telephone, and fax with our clients, physician's offices, and third-party providers, handling a high volume of complex calls while adjudicating incoming claims. There are cross-functional responsibilities to support other departments within CVS Health as required.Duties 1. Receive inbound and make outbound calls, correspond to emails from providers and clients, answer their questions, document the incidents, route incidents to appropriate parties, and ensure/facilitate ultimate resolution of stakeholder issues2. Adjudicate daily incoming primary and secondary paper claims, complete claims reporting, and resolve provider issues3. Perform User Provisioning functions such as password resets, unlock account(s), account setup(s) for internal and external user(s)4. Review and complete incoming Helpdesk tickets to support functions such as system navigation and report system issues to IT from internal and external partnersPay RangeThe typical pay range for this role is:Minimum: 17.02Maximum: 27.16Please 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+ years of experience in a healthcare or insurance customer service or call center environment. ● 1+ years of phone triage experience with proven track record handling high phone volume (20-40 calls/day). ● 1+ years of experience with Microsoft Office Applications.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications● Experience in a health care setting, claims processing, or pharmacy benefit industry. ● Basic knowledge of the medical insurance and third party process and terminology. ● Ability to adapt in a dynamic work environment, learn quickly, utilize advanced problem-solving skills and make decisions with minimal supervision. ●Basic alpha number data entry skills with attention to accuracy and quality. ● Intermediate math skills are required with attention to detail and quality. ●Ability to deliver outstanding customer service results through responsiveness, follow-through, and professionalism. ●Ability to effectively resolve customer issues and complaints through listening and responding to the customer in a positive and professional manner. ●Ability to consider alternative solutions before making decisions; makes timely and sound decisions based on adequate information; ability to identify and use appropriate resources to resolve multiple projects and demands through to completion. ●Ability to read and interpret policies, procedures and instructions. ●Ability to work with people in a team environment while meeting individual performance goals. ●Effective organizational skills and ability to prioritize a fluctuating workload and competing priorities.EducationHigh School Diploma or GED required. Associates Degree Preferred.Business OverviewBring your heart to CVS HealthEvery 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.

Created: 2025-09-06