Medical Claims Analyst

CVS Health Careers

. Perform initial review and triage of claims .

Posted 11/10/2026full-timeRemote • North Dakota • United StatesMid-LevelSenior💰 $19 - $42 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 healthcare environment.

Highest-signal resume keywords

Claims ProcessingEligibility VerificationMedical Terminology FamiliarityMicrosoft Office 365 ProficiencyCustomer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewAuthorization PreparationDocumentation MaintenanceNon-Medical ResearchTechnical Issue Resolution

Soft Skills

Effective CommunicationOrganizational SkillsCustomer ServiceTelephonic Skills

Tools & Technologies

Microsoft WordExcelVPNEHR PortalsTeams Messaging

Certifications & Qualifications

High School DiplomaG.E.DCEC/GPSMedCompass

Industry Keywords

Regulatory StandardsHIPAA ComplianceHealthcare ManagementRisk ManagementClaims Payment Issues

About the role

Key responsibilities & impact

Perform initial review and triage of claims
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 healthcare team effectiveness
Perform non-medical research and support
Comply with PM policies and regulatory standards
Maintain accurate and complete documentation for risk management, regulatory and accreditation requirements
Protect member confidentiality and follow company confidentiality policies
Assist in researching and resolving 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 within 7 feet of the modem/router
Minimum internet speed of 50 Mbps download and 5 Mbps upload
Quiet, secure and private designated home workspace 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
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
High School Diploma or G.E.D
Preferred: 2-4 years experience as a medical assistant, office assistant or claim processor
Preferred: CEC/GPS or MedCompass

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
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
CVS Health bonus, commission or short-term incentive program eligibility