Medical Claim Analyst
About the role
Inspects and provides accurate claim information to support savings optimization for claims. Responds to customers on benefit inquiries. Maintains customer service standards. Administers policies and procedures for medical cost management. Coordinates support functions for claim adjudication.
Responsibilities
- Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers.
- Follows area protocols, standards, and policies to provide effective and timely support.
- Reviews provider billing practices to identify trends and cost savings opportunities.
- Conducts training programs related to claim billing appropriateness and health plan guidelines for claim processors.
- Tests automated code review programs.
- Takes direction to execute techniques, processes, and responsibilities.
Requirements
- Working knowledge of problem solving and decision making skills
- Commercial Medicare Experience
- Understanding of: Claims policies and procedures
- Understanding of: Medical management concepts
Qualifications
- Healthcare claims processing
- Utilization management or authorization support
- Experience using healthcare systems such as: HRPRumbaMedCompass
Education
High school diploma or equivalent required.
Pay
The typical pay range for this role is $18.50 - $38.82 per hour. This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.
Benefits
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.
Schedule
Anticipated Weekly Hours: 40
Time Type: Full time