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.

Primary Job Duties & Responsibilities

• Analyzes and processes insurance claims to ensure complete accuracy, compliance, and timely payment for all patient claims.
• Evaluates the completeness and accuracy of claim forms, supporting documentation, and medical records.
• Determines the reimbursement or payment amounts based on policy coverage, fee schedules, negotiated rates, or other applicable guidelines.
• Ensures compliance with insurance regulations, industry standards, and internal policies when processing claims.
• Investigates and subsequently resolves claim denials or rejections by conducting research, consulting policy guidelines, and communicating with relevant parties.
• Analyzes claims data and documentation to determine coverage eligibility, adherence to policy terms and conditions, and compliance with regulatory requirements.
• Generates reports on claims processing metrics, such as claim volumes, reimbursement rates, denial rates, and turnaround times to provide insights and recommendations to improve efficiency, accuracy, and customer satisfaction.
• Provides clear and timely communication with patients to effectively review and resolve issues to ensure ongoing customer satisfaction.
• Identifies potential fraudulent or abusive activities by conducting fraud detection analysis, reviewing claims patterns, and collaborating with specialized fraud investigation teams.

Required Qualifications

• 3-5 years of experience in medical coding, claims analysis, and healthcare operations.

Preferred Qualifications

• Certified Professional Coder (CPC).
• Certified Billing and Coding Specialist (CBCS).
• Previous experience in provider coding.
• Strong time management skills.
• Ability to stay adaptable amidst a fast-paced environment.
• Strong multi-tasking ability.

Education

• Bachelor's degree or equivalent experience (4+ years of relevant experience + high school diploma or GED).

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $122,400.00

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 03/06/2026

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