Remote Medical Claims Analyst – Detail-Driven & Impactful

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

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.