Medical Claim Analyst

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

📋 Description

• Perform both routine and non-routine business support tasks for the Medical Claims department with minimal supervision.

• Adhere to established protocols, standards, and policies to ensure effective and timely assistance.

• Analyze the ECHS report daily to assign tasks to appeal nurses.

• Examine provider coding adjustments forwarded from non-clinical claims and prepare them for review by an Aetna clinician.

• Assess and process predetermination requests in accordance with CS Hub guidelines to establish eligibility for review.

• Handle CORR tasks to either work on them or reroute as necessary.

• Prioritize tasks and multitask effectively to manage projected workloads and deadlines.

• Verify and supply accurate claim information to enhance savings optimization.

• Address customer inquiries regarding benefits.

• Uphold customer service standards.

• Implement policies and procedures related to medical cost management.

• Coordinate support functions to facilitate claim adjudication.

⛳️ Requirements

• Proficient in problem-solving and decision-making skills.

• Over 5 years of relevant work experience.

• High school diploma or equivalent is mandatory.

• Availability to work 40 hours per week.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.