Medical Claim Analyst

CVS Health Careers

. Execute routine and non-routine business support tasks for the Medical Claims area under limited supervision .

Posted 11/6/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical claims processing, including reviewing provider coding edits and predetermination requests, while maintaining high customer service standards and adhering to policies for medical cost management.

Highest-signal resume keywords

Medical Claims ProcessingProblem Solving SkillsDecision-Making SkillsCustomer Service StandardsWorkload Prioritization

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewCoding EditsPredetermination RequestsTask ProcessingData Inspection

Soft Skills

MultitaskingEffective Communication

Tools & Technologies

CS Hub

Industry Keywords

Medical Cost ManagementClaim AdjudicationBenefit InquiriesECHS Report

About the role

Key responsibilities & impact

Execute routine and non-routine business support tasks for the Medical Claims area under limited supervision
Follow area protocols, standards, and policies to provide effective and timely support
Review the ECHS report daily for distribution of tasks to appeal nurses
Review provider coding edits routed from non-clinical claims and prepare them for review by an Aetna clinician
Review and process predetermination requests using CS Hub guidelines to determine review eligibility
Process CORR tasks to work or reroute as appropriate
Prioritize work and multitask to balance projected workload and due dates
Inspect and provide accurate claim information to support savings optimization
Respond to customers on benefit inquiries
Maintain customer service standards
Administer policies and procedures for medical cost management
Coordinate support functions for claim adjudication

Requirements

What you’ll need

Working knowledge of problem solving and decision-making skills
5+ years of work experience
High school diploma or equivalent required
Ability to work 40 hours per week

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program in addition to base pay