Remote Medical Claims Analyst – Fast-Paced, Detail‑Oriented

CVS Health; Bismarck (ND); Remote; USD 25,000 - 49,000; Full time

Job summary

CVS Health is seeking a Claims Processor to perform initial review and triage of claims, determine coverage, verify eligibility, and prepare authorizations. You will support medical staff, ensure timely processing, and maintain accurate documentation compliant with HIPAA.

Ideal candidates have strong communication, basic medical terminology knowledge, and solid computer skills. This remote role requires a quiet home office and reliable internet.

Qualifications

• Effective communication and organizational skills.
• Familiarity with basic medical terminology and care concepts.
• Strong customer service and issue-resolution abilities.
• Proficient in Excel and Word.

Responsibilities

• Initial review and triage of claims assigned for review.
• Determine coverage, verify eligibility, identify and redirect misdirects.
• Prepare authorizations in the system and triage cases to medical staff.
• Organize and prioritize work to meet regulatory and claim turnaround times.
• Promote internal and external communication to support medical management.
• Perform non-medical research and support.
• Adhere to Compliance with PM Policies and Regulatory Standards.
• Maintain accurate documentation meeting risk, regulatory, and accreditation requirements.
• Protect confidentiality of member information per company policies.
• Assist in researching and resolving claims payment issues.

Skills

Communication skills

Medical terminology

Customer service

MS Office (Excel, Word)

VPN access

EHR portal

Education

High School Diploma or GED

Tools

Microsoft Office 365

VPN

EHR portal

Job description

CVS Health is seeking a Claims Processor to perform initial review and triage of claims, determine coverage, verify eligibility, and prepare authorizations. You will support medical staff, ensure timely processing, and maintain accurate documentation compliant with HIPAA.

Ideal candidates have strong communication, basic medical terminology knowledge, and solid computer skills. This remote role requires a quiet home office and reliable internet.