Medical Claims Analyst

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🔥 3 hours ago

🐊 Florida, Louisiana, +3 more states – Remote

🐊 Florida – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🦀 Maryland – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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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

• Inspects and provides accurate claim information to support savings optimization for claims • Responds to customers on benefit inquiries • Maintains customer service standards • Administers policies and procedures for medical cost management • Coordinates support functions for claim adjudication • Executes both routine and non-routine business support tasks for the Medical Claims area • Follows area protocols, standards, and policies to provide effective and timely support • Reviews provider billing practices to identify trends and cost savings opportunities • Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors • Tests automated code review programs • Takes direction to execute techniques, processes, and responsibilities

🎯 Requirements

• Working knowledge of problem solving and decision making skills • 5+ years work experience • High school diploma or equivalent required

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package based on eligibility