Medical Claim Analyst

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

A Brief Overview
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.

What you will do

• 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.

• Review ECHS report daily for distribution of tasks to appeal nurses

• Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician.

• Using CS Hub guidelines, review, and process predetermination requests to determine review eligibility

• Process CORR tasks to work or reroute as appropriate

•  Prioritize work and multitasks to balance projected workload and due dates.

Required Qualifications

• Working knowledge of problem solving and decision-making skills

• 5+ years of work experience

Education

• High school diploma or equivalent required.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. 
 

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.