Medical Claim Analyst

This is a fully remote position, open to applicants in Alabama, +11 more locations.

📋 Description

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

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

• Daily review of the ECHS report for the allocation of tasks to appeal nurses.

• Assess provider coding edits received from non-clinical claims and prepare them for evaluation by an Aetna clinician.

• Review and process predetermination requests in accordance with CS Hub guidelines to ascertain review eligibility.

• Handle CORR tasks by either completing them or rerouting as necessary.

• Prioritize tasks and manage multiple responsibilities to keep up with projected workloads and deadlines.

• Analyze and provide precise claim information to enhance savings optimization for claims.

• Address customer inquiries regarding benefits while maintaining high customer service standards.

• Implement policies and procedures related to medical cost management.

• Coordinate support activities for claim adjudication.

⛳️ Requirements

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

• Minimum of 5 years of relevant work experience.

• High school diploma or equivalent is mandatory.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being, subject to eligibility.