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Medical Claim Analyst
CVS Health. Inspect and provide accurate claim information to support savings optimization .
Posted 10/16/2026full-timeRemote • Pennsylvania • United StatesMid-LevelSenior💰 $19 - $39 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims management, including claim adjudication, billing practices, and cost optimization strategies. Proficient in customer service and training related to health plan guidelines and policies.
Highest-signal resume keywords
Medical Claims ManagementClaim AdjudicationCustomer Service StandardsProblem Solving SkillsDecision Making Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claim Information InspectionCost ManagementBilling Practices ReviewAutomated Code Review TestingTraining Program Administration
Soft Skills
Customer Inquiry ResponseRoutine Business Support Execution
Certifications & Qualifications
High School Diploma or Equivalent
Industry Keywords
Medical Cost ManagementHealth Plan GuidelinesClaims OptimizationCost Savings Opportunities
About the role
Key responsibilities & impact- Inspect and provide accurate claim information to support savings optimization
- Respond to customers on benefit inquiries
- Maintain customer service standards
- Administer policies and procedures for medical cost management
- Coordinate support functions for claim adjudication
- Review provider billing practices to identify trends and cost savings opportunities
- Conduct training programs related to claim billing appropriateness and health plan guidelines
- Test automated code review programs
- Execute techniques, processes, and responsibilities under direction
Requirements
What you’ll need- High school diploma or equivalent required
- Executes routine and non-routine business support tasks for the Medical Claims area under limited supervision
- Follows area protocols, standards, and policies
- Working knowledge of problem solving and decision making skills
- 5+ years work experience 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 in addition to base pay