Medical Claims Analyst

This is a fully remote position, open to applicants in Alabama, +12 more locations.

📋 Description

• Perform an initial assessment and categorization of claims assigned for review.

• Assess coverage and confirm eligibility.

• Detect and redirect incorrectly directed claims.

• Generate authorizations within the system.

• Allocate cases to medical personnel for examination.

• Arrange and prioritize tasks to adhere to regulatory standards and claims turnaround deadlines.

• Foster communication both internally and externally to improve medical management services and enhance 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 that meets risk management, accreditation, and regulatory standards.

• Safeguard the confidentiality of member information.

• Investigate and address claims payment discrepancies.

⛳️ Requirements

• Strong verbal communication, organizational, and telephonic skills.

• Knowledge of fundamental medical terminology and concepts related to care.

• Excellent customer service abilities, including attentiveness to clients, sensitivity to concerns, and proactive problem-solving.

• Proficient in computer use, particularly with Excel and Microsoft Word.

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

• Minimum internet speed requirement of 50 Mbps for downloads and 5 Mbps for uploads.

• 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 be located in the state and city where currently residing.

• Experience working with multiple monitors and various applications.

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

• Familiarity with Microsoft Office 365 applications or similar Google Workspace tools.

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

• Ability to adhere to computer security protocols, including screen locking, managing strong passwords, and identifying suspicious emails or links.

• Competence in independently resolving common technical issues.

• Willingness to acquire new skills as the workplace evolves.

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

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

• High School Diploma or G.E.D.

🏝️ 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 available based on eligibility.

• Company-supplied equipment, including a keyboard, monitor, computer, and headset.