Medical Claim Analyst

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

Descripción de la vacante

CVS Health is seeking a dedicated team member in Texas to support medical claims and customer inquiries. The role focuses on inspecting and providing accurate claim information to optimize savings, while maintaining high customer service standards.

Responsibilities include processing both routine and non-routine tasks in the Medical Claims area, coordinating support functions, and ensuring compliance with policies.

Formación

• 5+ years of work experience in related field.
• High school diploma or equivalent required.
• Strong problem-solving and decision-making skills.

Responsabilidades

• Inspect and provide accurate claim information to support savings optimization.
• Respond to customers on benefit inquiries.
• Maintain customer service standards.
• Coordinates support functions for claim adjudication.

Conocimientos

Problem solving

Decision-making

Educación

High school diploma or equivalent

Descripción del empleo

Company Overview

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.

Application Window

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

Equal Opportunity Statement

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.