Remote Medical Claims Analyst - Triage & Coverage

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a remote Claims Processor to perform initial review and triage of medical claims, determine coverage, verify eligibility, and prepare authorizations. The role emphasizes timely processing, accurate documentation, and collaboration with medical staff to resolve issues while maintaining HIPAA compliance.

Ideal candidates will have strong communication, customer service skills, and familiarity with medical terminology, with proficiency in Excel and Word.

Qualifications

• Effective communication and organization skills.
• Familiarity with basic medical terminology used in care.
• Strong customer service skills to coordinate service delivery and resolve issues for members.
• Proficiency with Excel and Microsoft Word for documentation and reporting.

Responsibilities

• Review and triage claims assigned for review.
• Determine coverage and verify eligibility.
• Prepare authorizations in the system and route cases to medical staff.
• Organize and prioritize work to meet regulatory and turnaround times.
• Promote communication to enhance effectiveness of medical management services.
• Maintain documentation meeting risk, regulatory, and accreditation requirements.

Skills

Communication skills

Customer service

Medical terminology familiarity

IT/computer literacy

Education

High School Diploma or GED

Tools

Excel

Microsoft Word

EHR systems

Microsoft 365 (Teams, Outlook)

Job description

CVS Health is seeking a remote Claims Processor to perform initial review and triage of medical claims, determine coverage, verify eligibility, and prepare authorizations. The role emphasizes timely processing, accurate documentation, and collaboration with medical staff to resolve issues while maintaining HIPAA compliance.

Ideal candidates will have strong communication, customer service skills, and familiarity with medical terminology, with proficiency in Excel and Word.