Medical Claim Analyst

CVS Health

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

Posted 10/5/2026full-timeRemote • Virginia • United StatesMid-LevelSenior💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates proficiency in claims processing, eligibility verification, and medical terminology while ensuring compliance with regulatory standards. Excels in communication and organization to enhance healthcare team effectiveness and customer service.

Highest-signal resume keywords

Claims ProcessingEligibility VerificationMedical Terminology FamiliarityCustomer Service SkillsRegulatory Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ReviewAuthorization PreparationDocumentation MaintenanceIssue ResolutionComputer LiteracyExcel ProficiencyMicrosoft Word Proficiency

Soft Skills

Effective CommunicationOrganizational SkillsAttention to DetailProactive Problem Solving

Tools & Technologies

CEC/GPSMedCompass

Certifications & Qualifications

High School DiplomaG.E.D

Industry Keywords

Healthcare ManagementRisk ManagementRegulatory StandardsMember Information Confidentiality

About the role

Key responsibilities & impact

Perform 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
Adhere to PM policies, compliance requirements, and regulatory standards
Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
Protect member information confidentiality
Research and resolve 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
Attention to customers and sensitivity to issues
Proactive identification and resolution of issues
Computer literacy, including navigating internal and external computer systems
Excel and Microsoft Word proficiency
High School Diploma or G.E.D
2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred)
Familiarity with CEC/GPS or MedCompass (preferred)

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 supporting colleagues’ and families’ physical, emotional, and financial well-being