Medical Claim Analyst

Job not on LinkedIn

🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $18 - $35 / 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

• Conduct initial review and triage of claims assigned for review • Determine coverage and verify eligibility • Identify and redirect misdirected claims • Prepare authorizations in the system • Triage cases to medical staff for review • Organize and prioritize work to meet regulatory and claim turnaround times • Promote internal and external communication to enhance medical management services and healthcare team effectiveness • Perform non-medical research and support • Comply with PM policies and regulatory standards • Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements • Protect member confidentiality and follow company confidentiality policies • Assist in researching and resolving claims payment issues

🎯 Requirements

• Effective communication, telephonic and organization skills • Familiarity with basic medical terminology and concepts used in care • Strong customer service skills, including attention to customers, sensitivity to issues, and proactive issue resolution • Computer literacy, including Excel and Microsoft Word • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 50 Mbps download and 5 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide own workspace furniture • Ability to use multiple monitors and navigate multiple applications • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer and password security practices and recognize suspicious emails or links • Ability to troubleshoot common technical issues and contact IT when needed • Openness to learning new skills • High school diploma or G.E.D. • Preferred: 2–4 years of experience as a medical assistant, office assistant, or claim processor • Preferred: CEC/GPS or MedCompass experience

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program in addition to base pay

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