Medical Claim Analyst

4062 Aetna Resources, LLC; Pennsylvania; Hybrid; USD 25,000 - 54,000; Full time

Job summary

CVS Health is seeking a full-time Medical Claims support role to inspect and provide accurate claim information, respond to benefit inquiries, and ensure adherence to cost-management policies. You will coordinate support for claim adjudication and maintain service standards in a fast-paced healthcare environment.

Ideal candidates have strong problem solving and decision-making skills, with at least high school education and 5+ years of work experience in related areas.

Qualifications

• Executes routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations 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.
• Tests automated code review programs.

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 or equivalent

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.

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.

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.

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.

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.

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.