Medical Claim Analyst

Job not on LinkedIn

🔥 20 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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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 initial review and triage of claims tasked 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 information 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 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 virtual work location 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 simultaneously • 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 access secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to resolve common technical issues independently • High School Diploma or G.E.D • 2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred) • Experience with CEC/GPS or MedCompass (preferred)

🏖️ 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 including keyboard, monitor, computer, and headset • CVS Health bonus, commission or short-term incentive program in addition to base pay range (eligibility may apply)

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