Medical Claim Analyst
About The Position
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. A Brief Overview 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. What you will do Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers. Follows area protocols, standards, and policies to provide effective and timely support. Review ECHS report daily for distribution of tasks to appeal nurses Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician. Using CS Hub guidelines, review, and process predetermination requests to determine review eligibility Process CORR tasks to work or reroute as appropriate Prioritize work and multitasks to balance projected workload and due dates.
Requirements
- Working knowledge of problem solving and decision-making skills
- 5+ years of work experience
- High school diploma or equivalent required.
Responsibilities
- 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 under limited supervision, referring deviations from standard practices to managers.
- Follows area protocols, standards, and policies to provide effective and timely support.
- Review ECHS report daily for distribution of tasks to appeal nurses
- Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician.
- Using CS Hub guidelines, review, and process predetermination requests to determine review eligibility
- Process CORR tasks to work or reroute as appropriate
- Prioritize work and multitasks to balance projected workload and due dates.
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
