Medical Claim Analyst

4062 Aetna Resources, LLC; North Dakota; Hybrid; USD 38,000 - 81,000; Full time

Job summary

CVS Health is seeking a Medical Claims Support professional to inspect and provide accurate claim information, supporting savings optimization and responding to benefit inquiries.

You will administer policies for medical cost management, coordinate support for claim adjudication, and follow established procedures to deliver timely assistance to customers and providers.

Qualifications

• Minimum Requirements: Working knowledge of problem solving and decision making skills.
• Commercial Medicare Experience
• Understanding of: Claims policies and procedures
• Medical management concepts

Responsibilities

• 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.

Skills

Problem solving

Decision making

Commercial Medicare experience

Understanding of claims policies

Medical management concepts

Tools

HRP

Rumba

MedCompass

Job description

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. 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.

Minimum Requirements

Working knowledge of problem solving and decision making skills Commercial Medicare Experience Understanding of: Claims policies and procedures Medical management concepts

Preferred Qualifications

Healthcare claims processing Utilization management or authorization support Experience using healthcare systems such as: HRP Rumba MedCompass

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.

Benefits

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.

Application Window

We anticipate the application window for this opening will close on: 09/30/2026

Eligibility

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

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.