Medical Claims Analyst

Job not on LinkedIn

🔥 1 minute ago

🌾 North Dakota – Remote

🌾 North Dakota – Remote

💵 $18 - $42 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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

• Perform initial review and triage of claims • 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 for 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 • Computer literacy, including Excel and Microsoft Word • Direct/hardwired internet connection within 7 feet of the modem/router • Minimum internet speed of 50 Mbps download and 5 Mbps upload • Quiet, secure and private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Ability to use multiple monitors and navigate multiple applications • Ability to communicate via email, calendar invites, Teams messaging and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to follow computer and password security practices and recognize suspicious emails or links • Ability to resolve common technical issues independently • High School Diploma or G.E.D • Preferred: 2-4 years experience as a medical assistant, office assistant or claim processor • Preferred: CEC/GPS or MedCompass

🏖️ 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 eligibility

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