Medical Claim Analyst

CVS Health Corporation; Deutschland; Remote; USD 25,000 - 54,000; Full time

Job summary

CVS Health is seeking a Medical Claims Specialist to inspect and provide accurate claim information to support savings optimization. You will respond to benefit inquiries and maintain service standards while administering policies for medical cost management.

This full-time role involves reviews of provider billing practices, training on claim billing guidelines, and supporting claim processing under supervision, with a focus on quality and customer care.

Qualifications

• Working knowledge of problem solving and decision making.
• 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, 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.

Skills

Problem solving

Decision making

Commercial Medicare Experience

Claims policies and procedures

Medical management concepts

Education

High school diploma or equivalent

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

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: 09/30/2026

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