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 claim documentation review, verifies policy coverage, assesses claim validity, communicates with funeral homes, beneficiaries and family members, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of final expense claims for reimbursement through knowledge of life claims processes and effective communication skills.
Job Description
- Handles and processes final expense claims submitted by beneficiaries, ensuring accuracy, efficiency, and strict adherence to policies and guidelines.
- Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope.
- Documents claim information in the company system, assigning necessary data elements to ensure accurate tracking, reporting, and processing of claims.
- Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution.
- Communicates with funeral homes, beneficiaries, family members, or other stakeholders to resolve any discrepancies or issues related to claims.
- Determines if claims processing activities comply with regulatory requirements, industry standards, and company policies.
- Develops and implements regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
- Analyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department.
- Conducts outbound calls on an as needed bases to respective parties
Required Qualifications
- Must report into Franklin, TN office Tuesday- Thursday
- 1+ years experience in a high production environment
- Experience with Microsoft Office (specifically Excel)
- 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 in a final expense claims processing environment
Education
- HS Diploma
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $28.46This 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.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Report into Franklin, TN office Tuesday-Thursday
- 1+ years experience in a high production environment
- Experience with Microsoft Office (specifically Excel)
- 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
- High School Diploma
- 1-2 years experience in a final expense claims processing environment
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
