CVS Health एक अमेरिकी स्वास्थ्य सेवा कंपनी है, जो स्वास्थ्य सेवाओं, स्वास्थ्य बीमा, फार्मेसी लाभ प्रबंधन और रिटेल फार्मेसी के क्षेत्रों में काम करती है। Aetna और CVS Caremark जैसे व्यवसायों के माध्यम से यह स्वास्थ्य कवरेज, दवाओं तक पहुंच, रोग प्रबंधन, विशेष दवाओं और मेल-ऑर्डर फार्मेसी सेवाओं में सहायता प्रदान करती है। इसकी स्थानीय फार्मेसियां और व्यापक स्वास्थ्य सेवाएं लोगों को आवश्यक स्वास्थ्य देखभाल अधिक सुविधाजनक और किफायती तरीके से प्राप्त करने में मदद करने के लिए बनाई गई हैं। CVS Health बीमा, फार्मेसी और स्वास्थ्य सेवाओं को एक साथ लाकर लोगों और समुदायों को उनकी स्वास्थ्य यात्रा के दौरान सहयोग प्रदान करती है।
Medical Claims Analyst – Virginia Remote at CVS Health
Review medical claims, coverage, eligibility, authorizations, and payment concerns in a remote Virginia role with CVS Health. Support medical management and member care through accurate case handling and documentation.
विवरण
- Conduct initial reviews and triage claims assigned for examination
- Assess coverage and confirm member eligibility
- Recognize misdirected claims and route them appropriately
- Prepare claim-related authorizations in the designated system
- Refer cases to medical staff when clinical review is needed
- Plan and prioritize workloads to meet regulatory requirements and claim turnaround targets
- Strengthen communication across internal and external partners to support effective medical management and healthcare teams
- Complete non-medical research and related support activities
- Follow PM policies, compliance obligations, and regulatory standards
- Keep complete, accurate records that satisfy risk management, regulatory, and accreditation requirements
- Safeguard the confidentiality of member information
- Investigate and resolve medical claim payment issues
आवश्यकताएँ
- Clear communication, telephone, and organizational abilities
- Working knowledge of basic medical terminology and care-related concepts
- Strong customer service capabilities
- Customer awareness and sensitivity when handling concerns
- Ability to identify issues proactively and work toward resolution
- Computer literacy, including use of internal and external systems
- Proficiency with Microsoft Excel and Word
- High school diploma or GED
- Preferred: 2–4 years of experience as a medical assistant, office assistant, or claims processor
- Preferred: Familiarity with CEC/GPS or MedCompass
लाभ
- Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Additional resources supporting colleagues’ and families’ physical, emotional, and financial well-being