CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
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.
Description
- 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
Requirements
- 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
Benefits
- 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