Medical Claim Analyst

CVS Health Job OpportunityWe'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 OverviewInspects 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 DoExecutes 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.Minimum RequirementsWorking knowledge of problem solving and decision making skillsCommercial Medicare ExperienceUnderstanding of:Claims policies and proceduresMedical management conceptsPreferred QualificationsHealthcare claims processingUtilization management or authorization supportExperience using healthcare systems such as:HRPRumbaMedCompassEducationHigh school diploma or equivalent required.Anticipated Weekly Hours40Time TypeFull timePay Range$18.50 - $38.82This 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.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 PeopleWe 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.