Medical Claim Analyst

CVS Health; California; Híbrido; USD 25.000 - 53.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive benefits

Descripción de la vacante

CVS Health in California is seeking a full-time Medical Claims Support professional to inspect and provide accurate claim information, support savings optimization, and respond to benefit inquiries. You will administer policies for medical cost management and coordinate claim adjudication support tasks.

Responsibilities include executing routine and non-routine tasks, following protocols, reviewing reports and provider coding edits, processing predetermination requests, and prioritizing workload

Formación

• 5+ years of work experience.
• High school diploma or equivalent required.
• Working knowledge of problem solving and decision-making skills.

Responsabilidades

• Execute routine and non-routine business support tasks for Medical Claims under limited supervision.
• Follow area protocols, standards, and policies to provide effective and timely support.
• Review ECHS report daily for task distribution to appeal nurses.
• Review provider coding edits routed for review by an Aetna clinician.
• Using CS Hub guidelines, review predetermination requests to determine eligibility.
• Process CORR tasks to work or reroute as appropriate.
• Prioritize work and multitask to balance workload and due dates.

Conocimientos

Problem solving

Decision making

Educación

High school diploma or equivalent

Descripción del empleo

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

A Brief Overview

Inspects and provides accurate claim information to support savings optimization for claims. Responds to customers on benefit inquiries. Maintains customer service standards. Administers policies and procedures for medical cost management. Coordinates support functions for claim adjudication.

What you will do

• Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.

• Review ECHS report daily for distribution of tasks to appeal nurses
• Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician.
• Using CS Hub guidelines, review, and process predetermination requests to determine review eligibility
• Process CORR tasks to work or reroute as appropriate
• Prioritize work and multitasks to balance projected workload and due dates.

Required Qualifications

• Working knowledge of problem solving and decision-making skills
• 5+ years of work experience

Education

• High school diploma or equivalent required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $18.50 - $38.82

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.