Medical Claim Analyst

Job Description:

• Perform 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
• Adhere to PM policies, compliance requirements, and regulatory standards
• Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
• Protect member information confidentiality
• 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
• Attention to customers and sensitivity to issues
• Proactive identification and resolution of issues
• Computer literacy, including navigating internal and external computer systems
• Excel and Microsoft Word proficiency
• High School Diploma or G.E.D
• 2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred)
• Familiarity with CEC/GPS or MedCompass (preferred)

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 supporting colleagues’ and families’ physical, emotional, and financial well-being