Medical Claim Analyst

CVS Health Careers

. Conduct initial review and triage of claims tasked for review .

Posted 10/30/2026full-timeRemote • North Dakota • United StatesMid-LevelSenior💰 $19 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in claims processing, eligibility verification, and medical terminology while ensuring compliance with regulatory standards and maintaining confidentiality. Strong organizational and communication skills are essential for effective collaboration and customer service in a remote work environment.

Highest-signal resume keywords

Claims ProcessingEligibility VerificationMicrosoft Office 365Customer ServiceMedical Terminology

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewAuthorization PreparationDocumentation ManagementTechnical Issue ResolutionComputer Literacy

Soft Skills

Effective CommunicationOrganizational SkillsCustomer Service Skills

Tools & Technologies

Microsoft WordExcelVPNEHR PortalsTeams Messaging

Certifications & Qualifications

High School DiplomaG.E.DCEC/GPSMedCompass

Industry Keywords

Regulatory StandardsHIPAA ComplianceRisk ManagementMedical Management ServicesClaims Payment Issues

About the role

Key responsibilities & impact

Conduct initial review and triage of claims tasked for review
Determine coverage and verify eligibility
Identify and redirect misdirected claims
Prepare authorizations in the system
Triage cases to medical staff for review
Organize and prioritize work to meet regulatory and claim turnaround times
Promote internal and external communication to enhance medical management services and health care team effectiveness
Perform non-medical research and support
Comply with PM policies and regulatory standards
Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
Protect the confidentiality of member information
Research and resolve claims payment issues

Requirements

What you’ll need

Effective communication, telephonic and organization skills
Familiarity with basic medical terminology and concepts used in care
Strong customer service skills
Computer literacy, including Excel and Microsoft Word
Direct/hardwired internet connection to a modem/router within 7 feet of the computer
Minimum internet speed of 50 Mbps download and 5 Mbps upload
WiFi and satellite internet are not permitted
Quiet, secure and private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Ability to use multiple monitors and navigate multiple applications simultaneously
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 applications or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer and password security practices and recognize suspicious emails or links
Ability to resolve common technical issues independently
Openness to learning new skills as the workplace evolves
High School Diploma or G.E.D
CEC/GPS, or MedCompass preferred
2-4 years experience as a medical assistant, office assistant or claim processor preferred

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 eligibility
Company-provided equipment (keyboard, monitor, computer, headset, etc.)