Description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
CCR is responsible for post - service claim review to determine if specific
services can be reimbursed to providers and members.
- The analyst role is integral to the CCR team.
-They start the CCR process with the claim submission to CCR with a complete
review of the claim and claim history. They compile all system information,
claim history, plan information, and any additional research into template as
required by the workflow and any legal and regulatory requirements for a
clinician review.
-They also collaborate with Medical Directors as required.
-Review provider and member claims to determine if they meet CCR review requirements.
-Follow applicable workflows, templates, and legal and compliance
requirements to provide a complete picture of what is requiring review to the CCR clinicians and medical directors.
-Organizes and prioritizes work to help meet regulatory and CCR claim turn around times. Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and legal requirements.
-Works with all appropriate internal and external departments and personnel to accurately review specified claims and/or clarify any issues found in the course of the review.
-Required to work in multiple systems including EWM, ASD, ATV, MedCompass and HRP.
-Other systems dependent on specific reviews criteria.
-Maintains and utilizes all resource materials and systems to effectively manage job responsibilities
Adheres to company policies to protect member
confidentiality.

Required Qualifications
2+ years experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.

Preferred Qualifications
Knowledge of utilization management rules and regulations and claim processing guidelines.
Claims Processing/ customer service experience preferred

EducationVerifiable High School Diploma or GED.

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

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: 01/15/2026

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