CVS Health este o companie americană din domeniul sănătății, care activează în servicii medicale, asigurări de sănătate, gestionarea beneficiilor farmaceutice și farmacii cu vânzare cu amănuntul. Prin companii precum Aetna și CVS Caremark, aceasta sprijină acoperirea medicală, accesul la medicamente eliberate pe bază de rețetă, gestionarea afecțiunilor, medicamentele specializate și serviciile de farmacie prin comenzi prin poștă. Farmaciile sale de proximitate și serviciile extinse de îngrijire sunt concepute pentru a-i ajuta pe oameni să acceseze mai ușor și mai accesibil servicii medicale esențiale. CVS Health reunește asigurările, farmacia și serviciile de sănătate pentru a sprijini persoanele și comunitățile pe tot parcursul experienței lor de îngrijire.
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.
Descriere
- 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
Cerințe
- 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
Beneficii
- 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