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Medical Claim Analyst
CVS Health. Execute routine and non-routine business support tasks for the Medical Claims area under limited supervision .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims processing, including reviewing coding edits and predetermination requests, while ensuring adherence to policies and procedures for effective cost management. Strong multitasking and problem-solving abilities are essential for optimizing claim information and maintaining customer service standards.
Highest-signal resume keywords
Medical Claims ProcessingProblem SolvingDecision MakingCustomer ServiceCost Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ReviewProvider Coding EditsPredetermination RequestsTask PrioritizationData Inspection
Soft Skills
MultitaskingEffective Communication
Tools & Technologies
CS Hub
Industry Keywords
Medical ClaimsCost Management PoliciesAdjudication SupportECHS 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 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 for claims
- Respond to customers on benefit inquiries and 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
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to the base pay range
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility