Medical Claim Analyst

CVS Health•Work At Home-North Dakota, ND

2d•$19 - $39•Onsite

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. 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

Working knowledge of problem solving and decision making skills
Commercial Medicare Experience
Understanding of: Claims policies and procedures
Understanding of: Medical management concepts

Nice To Haves

Healthcare claims processing
Utilization management or authorization support
Experience using healthcare systems such as: HRP
Experience using healthcare systems such as: Rumba
Experience using healthcare systems such as: MedCompass

Responsibilities

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.