Medical Claim Analyst

Job not on LinkedIn

🔥 1 hour ago

🏈 Alabama, Arizona, +10 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍑 Georgia – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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 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 for claims • Respond to customers on benefit inquiries and 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

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • 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

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