Medical Claim Analyst

CVS Health

1d • $19 - $39

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary 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.

Requirements

• 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.
• 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.
• High school diploma or equivalent required.
• Anticipated Weekly Hours 40
• Time Type Full time

Nice To Haves

• Working knowledge of problem solving and decision making skills
• 5+ years work experience.

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.
• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED