Medical Claim Analyst

Virginia, Minnesota, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

High School Diploma or GED is required. Candidates should possess effective communication, telephonic, and organization skills, along with familiarity with basic medical terminology and concepts. Strong customer service skills are essential for coordinating service delivery, and computer literacy including proficiency in Excel and Microsoft Word is necessary. Preferred qualifications include 2-4 years of experience as a medical assistant, office assistant, or claim processor, and familiarity with ATV, HRP, or MedCompass.

Responsibilities

The Medical Claim Analyst is responsible for the initial review and triage of claims, determining coverage, verifying eligibility, and identifying and redirecting misdirected claims. This role involves prepping authorizations in the system and triaging cases to medical staff for review. The analyst must organize and prioritize work to meet regulatory and claim turn-around times, promote effective communication internally and externally, and perform non-medical research and support. Adherence to compliance with PM Policies and Regulatory Standards, maintaining accurate documentation, and protecting member confidentiality are also key responsibilities.

Skills

Medical Terminology

Claim Review

Eligibility Verification

Authorization Prep

Medical Management

Customer Service

Microsoft Excel

Microsoft Word

Communication

Organization

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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