Medical Claims Analyst

Job not on LinkedIn

🔥 21 minutes ago

🏈 Alabama, Arizona, +11 more states – Remote

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

💵 $18 - $42 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 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.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

Apply Now

Find Similar Remote Jobs

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 the confidentiality of member information • Research and resolve claims payment issues

🎯 Requirements

• Effective communication, telephonic and organization skills • Familiarity with basic medical terminology and concepts used in care • Strong customer service skills, including attention to customers, sensitivity to issues, and proactive identification and resolution of issues • 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 • Experience with multiple monitors and multiple applications • Ability to use 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 • Openness to learning new skills as the workplace environment evolves • 2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred) • Familiarity with CEC/GPS or MedCompass (preferred) • High School Diploma or G.E.D

🏖️ 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, based on eligibility • Company-provided equipment including keyboard, monitor, computer, and headset

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume