Medical Claim Analyst

This is a fully remote position, open to applicants in North Dakota.

📋 Description

• Conduct a preliminary assessment and sorting of claims assigned for review.

• Assess coverage and confirm eligibility.

• Recognize and redirect claims that have been misrouted.

• Enter authorizations into the system.

• Assign cases to medical personnel for further evaluation.

• Manage and prioritize tasks to adhere to regulatory standards and claim processing times.

• Foster communication both internally and externally to improve medical management services and the effectiveness of the healthcare team.

• Conduct non-medical research and provide support.

• Adhere to PM protocols and regulatory requirements.

• Ensure documentation is accurate and complete to meet risk management, regulatory, and accreditation standards.

• Safeguard the confidentiality of member information.

• Investigate and resolve issues related to claims payments.

⛳️ Requirements

• Strong communication, telephone, and organizational abilities.

• Basic understanding of medical terminology and concepts related to care.

• Exceptional customer service skills.

• Proficiency in computer applications, including Excel and Microsoft Word.

• A wired internet connection to a modem/router located within 7 feet of the computer.

• Minimum internet speeds of 50 Mbps for downloads and 5 Mbps for uploads.

• WiFi and satellite internet connections are not acceptable.

• A dedicated, quiet, and secure home workspace that complies with CVS Health and HIPAA standards.

• Must reside and work in the state and city of current residence.

• Capability to utilize multiple monitors and manage various applications concurrently.

• Proficient in communicating through email, calendar invitations, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 or similar Google Workspace applications.

• Ability to access secure systems, including VPN and EHR portals.

• Knowledge of computer and password security protocols and ability to identify suspicious emails or links.

• Competence in independently resolving common technical issues.

• Willingness to learn new skills as the workplace evolves.

• High School Diploma or G.E.D. required.

• CEC/GPS or MedCompass certification preferred.

• 2-4 years of experience as a medical assistant, office assistant, or claims processor preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources promoting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.

• Equipment provided by the company (keyboard, monitor, computer, headset, etc.).