Medical Claim Analyst

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

📋 Description

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

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

• Analyze provider billing practices to uncover trends and identify opportunities for cost savings.

• Facilitate training sessions concerning claim billing appropriateness and health plan guidelines for claim processors.

• Test automated code review software.

• Implement techniques, processes, and responsibilities as instructed.

• Address customer inquiries regarding benefits.

• Uphold customer service standards.

• Manage policies and procedures related to medical cost management.

• Coordinate support activities for claim adjudication.

⛳️ Requirements

• Proficient understanding of problem-solving and decision-making skills.

• Experience with Commercial Medicare.

• Familiarity with claims policies and procedures.

• Knowledge of medical management concepts.

• High school diploma or equivalent is mandatory.

• Preferred: Experience in healthcare claims processing.

• Preferred: Background in utilization management or authorization support.

• Preferred: Experience with healthcare systems such as HRP, Rumba, and MedCompass.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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