Medical Claims Analyst

CVS Health • Sacramento, CA

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.
A Brief Overview
Supports cost management programs to reduce medical claim expense and identify and recover medical claim expense dollars from liable parties. Gathers data and compiles cost analyses to identify cost-saving opportunities and cost reduction strategies to achieve financial goals.

Requirements

• 2-5 years work experience
• Adept at problem solving and decision making skills
• Promptly review, analyze and provide accurate claim information in order to optimize savings on appropriate claims
• Review claims and apply the correct pricing to the claim review
• Apply the appropriate contractual and plan benefits to claims reviewed
• Determines coverage, verifies eligibility, order of benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring correct claim adjudication
• 2+ years claim ACAS Medical claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.
• High School Diploma or G.E.D.

Nice To Haves

• Excel experience

Responsibilities

• Performs reviews and processing of claims to insurance carriers for payment to ensure accurate and timely claim submissions, helping patients receive the care they deserve.
• Maintains, enters, and organizes all claims reporting, communications, and discovery on claims in the claims drive or a claims administrative system to ensure industry-proven best practices are instilled within the company's strategies and end product offerings.
• Conducts analysis and conflict resolution to identify any errors or inconsistencies on initial claims submissions, ensuring claims are error-free and promptly resolved.
• Handles correspondence, claims, and referrals in the established timeframes and performance guarantees to ensure a high level of customer satisfaction and loyalty.
• Drafts first notice of claims, preservation of evidence letters, and email holds for litigation holds.
• Provides communication to and from Operations and other support departments for escalation of service-impacting issues.
• Prepares presentations and proposals to internal and external clients to successfully enhance the company's brand recognition and competitive advantage in the industry.
• Evaluates methods/processes after listening to customers and gathering feedback to proactively address and resolve customer service requests and issues.
• Presents status updates, issues and risks, and solutions to senior management, stakeholders, and partners to drive decision-making and actions.

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