Medical Claim Analyst

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary

• Review provider and member claims to determine if they meet CCR review requirements.
• Follow applicable workflows, templates, and legal and compliance requirements to provide a complete picture of what is requiring review to the CCR clinicians and medical directors.
• Organizes and prioritizes work to help meet regulatory and CCR claim turn around times.
• Determines coverage, verifies eligibility, benefits, identifies discrepancies, and applies reputed company Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and legal requirements.
• Works with reputed company appropriate internal and external departments and personnel to accurately review specified claims and/or clarify any issues reputed company in the course of the review.
• Maintains and utilizes reputed company resource materials and systems to effectively manage job responsibilities.
• Adheres to company policies to protect member confidentiality.

Required Qualifications

• 2+ years claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and reputed company.
• Customer service experience
• Knowledge of Medical Terminology

Preferred Qualifications

• Claims processing experience
• System knowledge: MedCompass, CEC, Rumba, etc.

Education

• High School Diploma or G.E.D.

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $42.35 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 07/21/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job