Medical Claim Analyst

CVS Health; Idaho; Hybrid; USD 25,000 - 53,000; Full time

Job summary

CVS Health in Idaho is seeking a full-time Claims Processor to inspect and provide accurate claim information to support savings and cost management for medical claims. You will respond to customer benefit inquiries, administer policies, and coordinate support functions for claim adjudication while maintaining high customer service standards.

Eligible applicants will have attention to detail, ability to work under limited supervision, and a commitment to equitable and efficient processing with a

Qualifications

• Executes routine and non-routine business support tasks for the Medical Claims area under limited supervision.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews provider billing practices to identify trends and cost savings opportunities.
• Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors.
• Tests automated code review programs.
• Takes direction to execute techniques, processes, and responsibilities.

Responsibilities

• 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.

Skills

Problem solving

Decision making

Education

High school diploma

Job description

Position Summary

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.

Required Qualifications

• 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.
• Reviews provider billing practices to identify trends and cost savings opportunities.
• Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors.
• Tests automated code review programs.
• Takes direction to execute techniques, processes, and responsibilities

Preferred Qualifications

• Working knowledge of problem solving and decision making skills
• 5+ years 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 (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 10/22/2026

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.