Medical Claims Analyst

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

📋 Description

• Conduct initial evaluations and categorization of claims.

• Assess coverage and confirm eligibility.

• Recognize and redirect claims that have been incorrectly directed.

• Generate authorizations within the system.

• Channel cases to medical personnel for assessment.

• Organize and prioritize tasks to adhere to regulatory requirements and claim processing timelines.

• Foster communication internally and externally to improve medical management services and enhance the effectiveness of the healthcare team.

• Carry out non-medical research and provide support.

• Adhere to PM policies and regulatory guidelines.

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

• Safeguard member confidentiality and comply with company confidentiality protocols.

• Assist in investigating and resolving issues related to claims payments.

⛳️ Requirements

• Strong communication, telephone, and organizational skills.

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

• Excellent customer service abilities.

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

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

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

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

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

• Capability to utilize multiple monitors and navigate various applications.

• Proficient in communicating through email, calendar invitations, Teams messaging, and virtual meetings.

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

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

• Knowledge of computer and password security practices and ability to identify suspicious emails or links.

• Competence in independently resolving common technical issues.

• High School Diploma or G.E.D.

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

• Preferred: CEC/GPS or MedCompass certification.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.