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

Performs medical claims review by ordering and evaluating medical records, verifying policy coverage, and assessing health conditions against policy requirements and application disclosures to determine claim validity. Communicates effectively with healthcare providers, policyholders, and beneficiaries to ensure timely and accurate processing of medical and final expense claims. Contributes to efficient claim handling through strong knowledge of medical record review processes, policy interpretation, and team collaboration.

Key Responsibilities

• Orders, handles and reviews medical records for contestable claims, ensuring accuracy, efficiency, and adherence to policies and guidelines. 

• Determines the eligibility and coverage of benefits for each policy based on the patient's insurance plan, health conditions, the scope of coverage, and policy guidelines. 

• Documents claim with medical records information in the system, assigning appropriate codes and other necessary data elements to ensure accurate tracking, reporting, and processing of claims in all appropriate applications. 

• Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. 

• Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims. 

• Determines if medical review activities comply with regulatory requirements, industry standards, and company policies. 

• Provides regular, timely feedback to frontline claims analysts to drive effective delivery of exceptional services and competencies.

Required Qualifications

• Must report into Franklin, TN office Tuesday- Thursday
• Experience in a high production environment
• Experience with Microsoft Office
• Ability to review and triage documents to the correct location
• Ability to multi-task, prioritize, & handle multiple workloads/assignments
• Ability to collaborate with team members to resolve any issues

Preferred Qualifications

• 1-2 years’ experience reviewing medical records 
• Medical coding knowledge 

 Education

• High school diploma or equivalent required.  
• Associate's degree or equivalent experience, preferred.

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: 05/22/2026

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