Medical Claims Analyst

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

📋 Description

• Assess and prioritize claims assigned for evaluation

• Establish coverage and confirm eligibility

• Recognize and reroute incorrectly directed claims

• Generate authorizations within the system

• Assign cases to medical personnel for assessment

• Organize and prioritize tasks to comply with regulatory requirements 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 standards

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

• 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

• Proficiency in computer applications, including Excel and Microsoft Word

• 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

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

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

• WiFi and satellite internet connections are not acceptable

• A quiet, secure, and private designated home office that complies with CVS Health and HIPAA standards

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

• Capability to utilize multiple monitors and navigate various applications

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

• Experience with Microsoft Office 365 or equivalent Google Workspace tools

• Ability to log into secure systems such as VPN and EHR portals

• Competence in following computer, password, and email security protocols

• Aptitude for independently troubleshooting common technical issues

• Willingness to learn new skills

🏝️ 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

• Options for retirement savings

• Wellness initiatives

• Additional resources supporting physical, emotional, and financial health

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