Medical Claim Analyst

CVS Health

Work At Home, WA

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JOB DETAILS

SALARY

$18.50–$38.82 Per Year

SKILLS

Analysis Skills, Communication Skills, Computer Skills, Computer Systems, Customer Support/Service, Documentation, Establish Priorities, Federal Laws and Regulations, GPS (Global Positioning System), Healthcare, High School Diploma, Identify Issues, Incentive Programs, Medical Office Administration, Medical Research, Medical Terminology, Microsoft Excel, Microsoft Word, Organizational Skills, Problem Solving Skills, Regulations, Risk Management, Safety/Work Safety, Service Delivery, State Laws and Regulations

LOCATION

Work At Home, WA

POSTED

Today

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** -Responsible for initial review and triage of claims tasked for review. -Determines coverage, verifies eligibility, identifies and redirects misdirects -Responsible for prepping the authorization in the system and triage cases to medical staff for review. -Organized and prioritizes work to meet regulatory and claim turn-around times -Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team. -Performs non-medical research and support -Adheres to Compliance with PM Policies and Regulatory Standards. -Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. -Protects the confidentiality of member information and adheres to company policies regarding confidentiality. -Assist in the research and resolution of claims payment issue **Required Qualifications** Effective communication, telephonic and organization skills. Familiarity with basic medical terminology and concepts used in care . -Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. -Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word **Preferred Qualifications** -2-4 years experience as a medical assistant, office assistant or claim processor -CEC/GPS, or MedCompass **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 - $38.82 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. 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 (https://learn.bswift.com/cvshealth-mainland) . We anticipate the application window for this opening will close on: 06/10/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.

About the Company

CVS Health

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.

COMPANY SIZE

10,000 employees or more

INDUSTRY

Biotechnology/Pharmaceuticals

WEBSITE

https://cvshealth.com/

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