Medical Claims Reviewer- Franklin, TN.

Job description

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 The Medical Reviewer plays a key role in supporting accurate and timely claim outcomes by managing all processes related to medical and policy history. This position involves reviewing health records, claims, and related documentation to ensure alignment with policy requirements and regulatory standards. The Medical Reviewer also coordinates with internal teams to provide guidance on benefit coverage and supports decision-making for claims within pre-existing and contestability periods. What you will do Manage and review medical and policy history to support claim and policy decisions. Review multiple health records, medical histories, claims, correspondence images, and bills from policyholders, agents, and providers. Compare bills to application information, policy requirements, and state regulations. Adhere to company and team processes to ensure timely and accurate policy and claim decisions. Coordinate with the Ancillary Claims processing and Audit Quality teams. Provide documentation and advisement on benefit coverage for services within policy pre-existing and contestability periods. Required Qualifications 1+ year of experience in administrative, customer service, healthcare support, claims processing, or other detail-oriented work involving document review and data accuracy. Experience using Microsoft Office applications (Outlook, Word, and Excel) to enter, review, and maintain accurate information. Preferred Qualifications Experience in healthcare, insurance, medical claims, or medical records. Strong analytical and problem-solving skills with the ability to compare information and identify discrepancies. Strong organizational skills with the ability to manage multiple tasks and meet deadlines. Education High school diploma or equivalent required. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $28.46 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: 10/20/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.