[Hiring] Medical Claim Analyst @CVS Health

Role Description

• Responsible for initial review and triage of claims tasked for review.
• Determines coverage, verifies eligibility, identifies and redirects misdirects.
• Responsible for prepping the authorization in the system and triage cases to medical staff for review.
• Organized and prioritizes work to meet regulatory and claim turn-around times.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team.
• Performs non-medical research and support.
• Adheres to Compliance with PM Policies and Regulatory Standards.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Assists in the research and resolution of claims payment issues.

Qualifications

• Effective communication, telephonic and organization skills.
• Familiarity with basic medical terminology and concepts used in care.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Requirements

• 2-4 years experience as a medical assistant, office assistant or claim processor.
• CEC/GPS, or MedCompass.

Education

• High School Diploma or G.E.D.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.