[Remote] Medical Claim Analyst at CVS Health

North Dakota, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

High School Diploma or G.E.D
Effective communication, telephonic and organization skills
Familiarity with basic medical terminology and concepts used in care
Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members
Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word

Responsibilities

Initial review and triage of claims tasked for review
Determines coverage, verifies eligibility, identifies and redirects misdirects
Preps the authorization in the system and triages cases to medical staff for review
Organizes and prioritizes work to meet regulatory and claim turn-around times
Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team
Performs non-medical research and support
Adheres to Compliance with PM Policies and Regulatory Standards
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Assists in the research and resolution of claims payment issues

Skills

Key technologies and capabilities for this role

medical terminologyclaims reviewcoverage determinationeligibility verificationauthorization prepExcelMicrosoft Wordcustomer servicetelephonic communicationclaims triage

Questions & Answers

Common questions about this position

What is the pay range for the Medical Claim Analyst position?

The typical pay range is $18.50 - $38.82 per hour. The actual base salary will depend on factors like experience, education, geography, and other relevant factors, and the position is eligible for a CVS Health bonus, commission, or short-term incentive program.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What skills are required for the Medical Claim Analyst role?

Required skills include effective communication (telephonic), organization, familiarity with basic medical terminology, strong customer service skills, and computer literacy including Excel and Microsoft Word.

What is the company culture like at CVS Health?

CVS Health fosters a workplace where every colleague feels valued and belongs, with teams reflecting the customers, patients, members, and communities served, and emphasizes passion for transforming health care with heart.

What makes a strong candidate for this Medical Claim Analyst position?

A strong candidate has a High School Diploma or G.E.D, effective communication and organization skills, familiarity with medical terminology, customer service experience, computer literacy, and preferably 2-4 years as a medical assistant, office assistant, or claim processor.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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