Medical Claim Analyst

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – 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 Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• Responsible for initial review and triage of claims tasked for review • Determines coverage, verifies eligibility, identifies and redirects misdirects • Responsible for prepping the authorization in the system and triage cases to medical staff for review • Organized and prioritizes work to meet regulatory and claim turn-around times • Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team • Performs non-medical research and support • Adheres to Compliance with PM Policies and Regulatory Standards • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements • Protects the confidentiality of member information and adheres to company policies regarding confidentiality • Assist in the research and resolution of claims payment issue

🎯 Requirements

• Effective communication, telephonic and organization skills • Familiarity with basic medical terminology and concepts used in care • Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members • Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word • 2-4 years experience as a medical assistant, office assistant or claim processor • CEC/GPS, or MedCompass • High School Diploma or G.E.D

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs and other resources