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Medical Claims Analyst

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CVS Health

20d ago

  • Job
    Full-time
    Junior, Mid & Senior Level
  • Accounting & Tax
    Healthcare
  • Sacramento
  • 8hrs left

AI generated summary

  • You need 2-5 years of experience, 2+ years in ACAS Medical claim processing, problem-solving skills, Excel proficiency, and a High School Diploma or G.E.D.
  • You will review and process claims, resolve issues, maintain documentation, communicate with teams, prepare presentations, and ensure accurate claim adjudication for optimal patient care.

Requirements

  • 2-5 years work experience
  • Adept at problem solving and decision making skills
  • 2+ years claim ACAS Medical claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.
  • Excel experience
  • Education High School Diploma or G.E.D.

Responsibilities

  • Performs reviews and processing of claims to insurance carriers for payment to ensure accurate and timely claim submissions, helping patients receive the care they deserve.
  • Maintains, enters, and organizes all claims reporting, communications, and discovery on claims in the claims drive or a claims administrative system to ensure industry-proven best practices are instilled within the company's strategies and end product offerings.
  • Conducts analysis and conflict resolution to identify any errors or inconsistencies on initial claims submissions, ensuring claims are error-free and promptly resolved.
  • Handles correspondence, claims, and referrals in the established timeframes and performance guarantees to ensure a high level of customer satisfaction and loyalty.
  • Drafts first notice of claims, preservation of evidence letters, and email holds for litigation holds.
  • Provides communication to and from Operations and other support departments for escalation of service-impacting issues.
  • Prepares presentations and proposals to internal and external clients to successfully enhance the company's brand recognition and competitive advantage in the industry.
  • Evaluates methods/processes after listening to customers and gathering feedback to proactively address and resolve customer service requests and issues.
  • Presents status updates, issues and risks, and solutions to senior management, stakeholders, and partners to drive decision-making and actions.
  • Promptly review, analyze and provide accurate claim information in order to optimize savings on appropriate claims.
  • Review claims and apply the correct pricing to the claim review.
  • Apply the appropriate contractual and plan benefits to claims reviewed.
  • Determines coverage, verifies eligibility, order of benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring correct claim adjudication.

FAQs

What is the job title for this position?

The job title for this position is Medical Claims Analyst.

What types of claims will I be reviewing and processing?

You will be reviewing and processing medical claims to insurance carriers for payment.

What is the minimum work experience required for this role?

The minimum work experience required for this role is 2-5 years.

What qualifications are preferred for this position?

Excel experience is preferred for this position.

What educational background is required for the Medical Claims Analyst job?

A High School Diploma or G.E.D. is required for this position.

What are the typical weekly hours for this role?

The typical weekly hours for this role are 40 hours.

What is the pay range for the Medical Claims Analyst position?

The typical pay range for this role is $18.50 - $38.82 per hour.

What type of benefits does CVS Health offer to employees?

CVS Health offers affordable medical plan options, a 401(k) plan, employee stock purchase plans, wellness programs, paid time off, flexible work schedules, tuition assistance, and more depending on eligibility.

How does CVS Health prioritize workplace inclusion?

CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong, reflecting the diversity of the customers, patients, members, and communities they serve.

Is there an application window for this job opening?

Yes, the application window for this opening will close on 02/18/2026.

Will my previous arrest or conviction records affect my application?

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

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CVS Health

Bringing our heart to every moment of your health.

Science & Healthcare
Industry
10,001+
Employees
1963
Founded Year

Mission & Purpose

CVS Health is a healthcare innovation company that operates retail pharmacies, manages pharmacy benefits, and provides health services through its MinuteClinic and HealthHUB locations. Their ultimate aim is to improve the quality of life for communities by making healthcare more accessible and affordable. CVS Health focuses on driving healthier outcomes and reducing healthcare costs, using its comprehensive range of services and products to support individuals on their health journey.