Medical Claim Analyst

CVS Health

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

Posted 11/12/2026full-timeRemote • Virginia • 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 virtual work 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 ManagementNon-Medical ResearchTechnical Issue Resolution

Soft Skills

Effective CommunicationOrganizational SkillsTelephonic Skills

Tools & Technologies

Microsoft WordExcelVPN AccessEHR PortalsTeams Messaging

Certifications & Qualifications

High School DiplomaG.E.D

Industry Keywords

Regulatory ComplianceHIPAA GuidelinesRisk 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 healthcare 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 member information 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 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, private designated home virtual 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 access secure systems such as VPN and EHR portals
Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links
Ability to resolve common technical issues independently
High School Diploma or G.E.D
2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred)
Experience with CEC/GPS or MedCompass (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
Company-provided equipment including keyboard, monitor, computer, and headset
CVS Health bonus, commission or short-term incentive program in addition to base pay range (eligibility may apply)