Remote Medical Claims Analyst

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Job summary

CVS Health is hiring for a full-time Claims Processor to support remote, home-based work in the United States. The role involves initial review and triage of claims, determining coverage, verifying eligibility, and preparing authorizations for medical staff review.

You will prioritize work to meet regulatory turn-around times and maintain documentation while ensuring confidentiality. Strong communication, medical terminology familiarity, and customer service skills are essential.

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

Responsibilities

• Initial review and triage of claims tasked for review.
• Determines coverage, verifies eligibility, identifies and redirects misdirects.
• Prep 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, 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

Skills

Communication skills

Medical terminology

Customer service

Microsoft Word & Excel

Education

High School Diploma or GED

Tools

Excel

Microsoft Word

PowerPoint

Outlook

Job description

CVS Health is hiring for a full-time Claims Processor to support remote, home-based work in the United States. The role involves initial review and triage of claims, determining coverage, verifying eligibility, and preparing authorizations for medical staff review.

You will prioritize work to meet regulatory turn-around times and maintain documentation while ensuring confidentiality. Strong communication, medical terminology familiarity, and customer service skills are essential.