Medical Claim Analyst

Job not on LinkedIn

🔥 1 minute ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Execute routine and non-routine business support tasks for the Medical Claims area under limited supervision • Follow area protocols, standards, and policies to provide effective and timely support • Review the ECHS report daily for distribution of tasks to appeal nurses • Review provider coding edits routed from non-clinical claims and prepare them for review by an Aetna clinician • Review and process predetermination requests using CS Hub guidelines to determine review eligibility • Process CORR tasks to work or reroute as appropriate • Prioritize work and multitask to balance projected workload and due dates • Inspect and provide accurate claim information to support savings optimization • Respond to customers on benefit inquiries • Maintain customer service standards • Administer policies and procedures for medical cost management • Coordinate support functions for claim adjudication

🎯 Requirements

• Working knowledge of problem solving and decision-making skills • 5+ years of work experience • High school diploma or equivalent required • Ability to work 40 hours per week

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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