CVS Health
CVS Health
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.

Remote Medical Claims Analyst — North Dakota | CVS Health

Review, authorize, and route medical claims for CVS Health. Check eligibility, documentation, and compliance, and resolve payment issues.

Descriere

  • Review and triage claims assigned for assessment
  • Confirm coverage and verify member eligibility
  • Spot misdirected claims and route them appropriately
  • Enter authorizations in the system
  • Refer cases to medical staff for review
  • Prioritize work to meet regulatory requirements and claims turnaround times
  • Support effective medical management and care teams through internal and external communication
  • Provide non-medical research and assistance
  • Follow PM policies and applicable regulations
  • Keep complete, accurate records for risk management, regulatory, and accreditation needs
  • Safeguard confidential member information
  • Investigate and resolve claims payment issues

Cerințe

  • Communicate effectively by phone and stay organized
  • Know basic medical terminology and care concepts
  • Provide strong customer service
  • Use computers, including Excel and Microsoft Word
  • Preferably have 2–4 years of experience as a medical assistant, office assistant, or claims processor
  • CEC/GPS or MedCompass experience is preferred
  • Have a high school diploma or GED
  • Use a direct, wired internet connection to a modem or router located within 7 feet of the computer
  • Have internet service with at least 50 Mbps download and 5 Mbps upload speeds
  • Wi-Fi and satellite internet connections are not permitted
  • Maintain a quiet, secure, private designated home workspace that meets CVS Health and HIPAA guidelines
  • Work from the state and city where you currently live
  • Use multiple monitors and navigate multiple applications
  • Use email, calendar invitations, Teams messaging, and virtual meetings
  • Have experience with Microsoft Office 365 or similar Google Workspace tools
  • Log in to secure systems such as VPNs and EHR portals
  • Follow computer, password, and email security practices
  • Troubleshoot common technical issues independently
  • Be open to learning new skills

Beneficii

  • May qualify 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
  • Resources supporting physical, emotional, and financial well-being
  • Company-provided equipment, such as a keyboard, monitor, computer, and headset

Locuri de muncă similare

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Investigate and resolve complex general liability and auto claims remotely for Intercare Holdings Insurance Services. The role covers liability and coverage analysis, reserves, litigation counsel, settlements, and client reporting.

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