Remote Medical Claims Analyst - Triage & Resolve

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

Benefits offered by this job

Medical, dental and vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health is hiring for a claims triage role focused on initial review, eligibility verification, and proper routing to medical staff. You will handle non-medical research, documentation, and confidentiality while prioritizing timely processing of claims.

The position emphasizes strong communication, accuracy, and collaboration with health care teams, all within a comprehensive benefits program and performance incentives.

Qualifications

• Strong communication and organization skills.
• Familiarity with medical terminology used in care.
• Excellent customer service with proactive issue resolution.
• Proficiency with Microsoft Office 365 applications.

Responsibilities

• Perform initial review and triage of claims for review.
• Determine coverage and verify eligibility; identify misdirects and redirect.
• Prepare authorization in the system and triage cases to medical staff for review.
• Maintain documentation meeting regulatory and risk management requirements.
• Protect confidentiality of member information per policy.

Skills

Communication

Medical terminology

Customer service

Microsoft Office

Education

High School Diploma or GED

Tools

Excel

Microsoft Word

Job description

CVS Health is hiring for a claims triage role focused on initial review, eligibility verification, and proper routing to medical staff. You will handle non-medical research, documentation, and confidentiality while prioritizing timely processing of claims.

The position emphasizes strong communication, accuracy, and collaboration with health care teams, all within a comprehensive benefits program and performance incentives.