Medical Claim Analyst

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

📋 Description

• Perform initial assessments and triage of claims assigned for evaluation.

• Assess coverage and confirm eligibility status.

• Recognize and redirect incorrectly directed claims.

• Generate authorizations within the system.

• Route cases to medical personnel for evaluation.

• Organize and prioritize tasks to adhere to regulatory and claims processing timelines.

• 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 policies and regulatory requirements.

• Ensure accurate and complete documentation that meets risk management, regulatory, and accreditation standards.

• Safeguard the confidentiality of member information and comply with company confidentiality protocols.

• Aid in investigating and resolving claims payment discrepancies.

⛳️ Requirements

• Strong communication, telephonic, and organizational abilities.

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

• Excellent customer service skills, including attentiveness to clients, sensitivity to concerns, and proactive identification and resolution of issues.

• Computer proficiency, including the ability to navigate both internal and external computer systems.

• Competence in Excel and Microsoft Word.

• High School Diploma or G.E.D.

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

• Familiarity with CEC/GPS or MedCompass (preferred).

🏝️ 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.