# Claims Reviewer

**Company**: CVS Health
**Location**: Work from home, ND
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $18.50 - $35.29
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/ND---Work-from-home/Medical-Claim-Analyst_R1071218?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_a5cd8700-7b9

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.

**Position Summary**

- Responsible for initial review and triage of claims tasked for review.

- Determines coverage, verifies eligibility, identifies and redirects misdirects.

- Prepares authorizations in the system and triages cases to medical staff for review.

- Organizes and prioritizes work to meet regulatory and claim turn-around times.

- Promotes communication, both internally and externally, to enhance effectiveness of medical management services and health care team.

- Performs non-medical research and support.

- Adheres to Compliance with PM Policies and Regulatory Standards.

- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

- Assists in the research and resolution of claims payment issues.

**Required Qualifications**

- Effective communication, telephonic, and organization skills.

- Familiarity with basic medical terminology and concepts used in care.

- Strong customer service skills to coordinate service delivery, including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.

- Computer literacy to navigate through internal/external computer systems, including Excel and Microsoft Word.

**Work from Home Requirements**

- Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of computer and a minimum download speed of 50 Mbps download and 5 Mbps upload.

- A quiet, secure, and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture.

**Technical and Logistical Requirements**

- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.

- Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.

- Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.

- Ability to log in to secure systems, lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.

- Ability to resolve common technical issues independently.

- Openness to learning new skills in the future as the workplace environment evolves.

**Preferred Qualifications**

- 2-4 years of experience as a medical assistant, office assistant, or claim processor.

- CEC/GPS, or MedCompass.

**Education**

- High School Diploma or G.E.D.

**Anticipated Weekly Hours**

- 40

**Time Type**

- Full-time

**Pay Range**

- $18.50 - $35.29

## Skills

### Required
- Microsoft Office 365
- Excel
- Microsoft Word
- communication skills
- organizational skills
- medical terminology

### Nice to have
- CEC/GPS
- MedCompass
- medical assistant experience
- office assistant experience
- claim processor experience

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/ND---Work-from-home/Medical-Claim-Analyst_R1071218?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)