Medical Claim Analyst
Job Description:
- Perform initial review and triage of claims tasked for review
- Determine coverage and verify eligibility
- Identify and redirect misdirected claims
- Prepare authorizations in the system
- Triage cases to medical staff for review
- Organize and prioritize work to meet regulatory and claim turnaround times
- Promote internal and external communication to enhance medical management services and healthcare team effectiveness
- Perform non-medical research and support
- Adhere to PM policies, compliance requirements, and regulatory standards
- Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
- Protect member information confidentiality
- Research and resolve claims payment issues
Requirements:
- Effective communication, telephonic, and organization skills
- Familiarity with basic medical terminology and concepts used in care
- Strong customer service skills
- Attention to customers and sensitivity to issues
- Proactive identification and resolution of issues
- Computer literacy, including navigating internal and external computer systems
- Excel and Microsoft Word proficiency
- High School Diploma or G.E.D
- 2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred)
- Familiarity with CEC/GPS or MedCompass (preferred)
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting colleagues’ and families’ physical, emotional, and financial well-being
