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
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