Medical Claims Analyst

CVS Health; Montana; Hybrid; USD 25,000 - 58,000; Full time

Job summary

CVS Health is seeking a remote claims reviewer responsible for the initial review and triage of claims. You will determine coverage, verify eligibility, prepare authorizations, and triage to medical staff for review while maintaining regulatory-compliant documentation and confidentiality of member information.

The role emphasizes strong communication, medical terminology familiarity, and Microsoft Office proficiency to support efficient health care services.

Qualifications

• Effective communication and organization skills.
• Familiarity with basic medical terminology used in care.
• Strong customer service to coordinate service delivery.
• Computer literacy including Excel and Word.

Responsibilities

• Initial review and triage of claims assigned for review.
• Determines coverage and verifies eligibility.
• Preps authorization in the system and triages cases to medical staff for review.
• Organizes and prioritizes work to meet regulatory and claim turnaround times.
• Maintains documentation meeting risk management, regulatory and accreditation requirements.
• Protects confidentiality of member information.

Skills

Communication skills

Medical terminology

Customer service

Organization

Education

High School Diploma or GED

Tools

Microsoft Office 365

Excel

Word

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

• Responsible for initial review and triage of claims tasked for review.
• Determines coverage, verifies eligibility, identifies and redirects misdirects
• Responsible for prepping the authorization in the system and triage cases to medical staff for review.
• Organized and prioritizes work to meet regulatory and claim turn‑around times
• Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team.
• Performs non-medical research and support
• Adheres to Compliance with PM Policies and Regulatory Standards.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Assist in the research and resolution of claims payment issue

Required Qualifications

• Effective communication, telephonic and organization skills.
• Familiarity with basic medical terminology and concepts used in care.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 50 Mbps download and 5 Mbps upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Preferred Qualifications

• 2-4 years experience as a medical assistant, office assistant or claim processor
• CEC/GPS, or MedCompass

Education

High School Diploma or G.E.D

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

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 (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 11/13/2026

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.