Health/Medical Claims Processor I

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.
Position Summary
The Medical Claim Analyst will be part of the Provider Coding and Reimbursement (PCR) team who reviews provider coding and reimbursement denial disputes from providers.
This function includes, but is not limited to the following:

• Review provider re-submissions of ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix and DRG claims and resolve or prepare them for review by an Aetna clinician.
• Prioritize work and be able to multitask to balance projected workload and due dates.
• Review provider rework claims in accordance with claim processing and PCR guidelines.
• Research claims in the ASD or ACAS/EWM systems.
• Research and document claim history in Aetna Strategic Desktop (ASD) and Electronic Correspondence Handling System (ECHS).

Required Qualifications

• Extensive knowledge of the Aetna ACAS claims platform and a minimum of 1 year of ACAS claim processing experience.
• Ability to review claims
• Rework experience, EWM, ASD and ECHS
• Knowledge of functionality in systems including IFP, HRP, etc. for the exchanges support.
• Work within Excel spreadsheets when needed.
• Communicate and collaborate effectively with other team members and departments within Aetna.
• Work independently and as part of a team.
• Prioritize work and be able to multitask to balance project workload and due dates.
• Provide excellent service by meeting quality, turnaround key performance metrics, and meeting productivity expectations.

Preferred Qualifications

• ACAS/EWM experience is highly preferred.
• Claims processing experience is a plus.
• Solid track record of excellent quality results with a strong claim background.
• Good analytical and technical skills.
• Strong knowledge of benefit plans, policies and procedures
• Demonstrated ability to handle multiple assignments competently, accurately and efficiently.
• Strong attention to detail.

Education
• High School diploma, G.E.D. or equivalent experience.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $35.29
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.
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.

We anticipate the application window for this opening will close on: 08/29/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.