Medical Claim Analyst

Job not on LinkedIn

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

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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

• Conduct post-service claim review to determine whether services can be reimbursed to providers and members • Initiate the CCR process with complete review of claims and claim history • Compile system information, claim history, plan information, and additional research into required templates • Collaborate with clinicians and Medical Directors as required • Review provider and member claims against CCR review requirements • Follow workflows, templates, legal, and compliance requirements • Organize and prioritize work to meet regulatory and CCR claim turnaround times • Determine coverage, verify eligibility and benefits, identify discrepancies, and apply Medical Claim Management policies and procedures • Work with internal and external departments and personnel to review claims and clarify issues • Use multiple systems, including EWM, ASD, ATV, MedCompass, and HRP • Maintain and use resource materials and systems to manage job responsibilities • Protect member confidentiality according to company policies

🎯 Requirements

• 2+ years of experience • Demonstrated ability to handle multiple assignments competently, accurately, and efficiently • Knowledge of utilization management rules and regulations and claim processing guidelines preferred • Claims processing or customer service experience preferred • Verifiable High School Diploma or GED • Ability to work in multiple systems, including EWM, ASD, ATV, MedCompass, and HRP • Ability to adhere to legal, regulatory, compliance, and confidentiality requirements

🏖️ 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