Medical Claim Analyst

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

📋 Description

• Conduct initial assessments and triage of claims assigned for evaluation

• Assess coverage and confirm eligibility

• Recognize and redirect claims that have been incorrectly directed

• Generate authorizations within the system

• Route cases to medical personnel for assessment

• Structure and prioritize tasks to comply with regulatory and claims turnaround timelines

• Foster internal and external communication to improve medical management services and enhance the efficiency of the healthcare team

• Execute non-medical research and provide support

• Comply with PM policies, regulatory standards, and compliance obligations

• Ensure accurate and thorough documentation that meets risk management, regulatory, and accreditation criteria

• Safeguard the confidentiality of member information

• Investigate and resolve issues related to claims payments

⛳️ Requirements

• Strong communication, telephonic, and organizational abilities

• Knowledge of basic medical terminology and concepts relevant to care

• Excellent customer service skills

• Attentiveness to customers and sensitivity to their concerns

• Proactive in identifying and resolving issues

• Proficient in computer usage, including navigating both internal and external systems

• Competency 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 base salary

• Medical insurance coverage

• Dental insurance coverage

• Vision insurance coverage

• Paid time off

• Retirement savings plans

• Wellness initiatives

• Additional resources to support the physical, emotional, and financial well-being of colleagues and their families