Medical Claim Analyst

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

📋 Description

• Perform initial evaluations and triage of claims assigned for review.

• Assess coverage and confirm eligibility.

• Detect and redirect misrouted claims.

• Generate authorizations within the system.

• Direct cases to medical personnel for assessment.

• Organize and prioritize tasks to adhere to regulatory standards and claims turnaround times.

• Foster internal and external communication to improve medical management services and the effectiveness of the healthcare team.

• Conduct non-medical research and provide support.

• Adhere to PM policies and regulatory requirements.

• Ensure accurate and thorough documentation for risk management, regulatory, and accreditation purposes.

• Safeguard member information confidentiality and comply with company confidentiality policies.

• Assist in investigating and resolving claims payment discrepancies.

⛳️ Requirements

• Strong communication, telephonic, and organizational abilities.

• Understanding of basic medical terminology and concepts relevant to care.

• Excellent customer service skills.

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

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speed of 50 Mbps download and 5 Mbps upload.

• WiFi and satellite internet connections are not allowed.

• A quiet, secure, and private designated home workspace that complies with CVS Health and HIPAA regulations.

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

• Capability to operate multiple monitors and navigate various applications.

• Proficient in using email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to access secure systems such as VPN and EHR portals.

• Competence in following computer security practices, including using strong passwords and identifying suspicious emails or links.

• Skills in troubleshooting common technical issues.

• Willingness to acquire new skills.

• Preferred: 2–4 years of experience as a medical assistant, office assistant, or claims processor.

• Preferred: CEC/GPS or MedCompass certification.

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

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.

• Company-provided equipment (keyboard, monitor, computer, headset, etc.).