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CVS HealthPosted 10/20/2026full-timeRemote • North Dakota • United StatesMid-LevelSenior💰 $19 - $35 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in claims review, eligibility verification, and documentation compliance while ensuring effective communication and customer service. Capable of navigating secure systems and utilizing Microsoft Office 365 to enhance operational efficiency.
Highest-signal resume keywords
Claims ReviewEligibility VerificationMicrosoft Office 365Customer ServiceMedical Terminology
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 for 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 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
- Ability to use email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 or similar Google Workspace applications
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer security practices, including strong passwords and recognizing suspicious emails or links
- Ability to troubleshoot common technical issues
- Openness to learning new skills
- Preferred: 2–4 years of experience as a medical assistant, office assistant, or claim processor
- Preferred: CEC/GPS or MedCompass
- High School Diploma or G.E.D.
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources based on eligibility
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
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 ProcessingDocumentation ComplianceMedical TerminologyTechnical TroubleshootingComputer Literacy
Soft Skills
Effective CommunicationOrganizational SkillsCustomer Service Skills
Tools & Technologies
Microsoft WordExcelTeams MessagingVPNEHR Portals
Certifications & Qualifications
High School DiplomaG.E.D.CEC/GPSMedCompass
Industry Keywords
Regulatory StandardsHIPAA ComplianceRisk ManagementHealthcare ManagementClaims Payment Issues