Medical Claim Analyst

Job not on LinkedIn

🔥 12 hours ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 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 provider billing practices to identify trends and cost savings opportunities • Conduct training programs related to claim billing appropriateness and health plan guidelines for claim processors • Test automated code review programs • Execute techniques, processes, and responsibilities as directed • Respond to customers on benefit inquiries • Administer policies and procedures for medical cost management • Coordinate support functions for claim adjudication

🎯 Requirements

• Working knowledge of problem solving and decision making skills • Commercial Medicare Experience • Understanding of claims policies and procedures • Understanding of medical management concepts • High school diploma or equivalent required • Healthcare claims processing experience preferred • Utilization management or authorization support experience preferred • Experience using healthcare systems such as HRP, Rumba, and MedCompass preferred

🏖️ Benefits

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