FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Core Competencies
Role fitCore 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 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
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ReviewAuthorization PreparationDocumentation ManagementTechnical Issue ResolutionComputer Literacy
Soft Skills
Effective CommunicationOrganizational SkillsAttention to DetailProactive Problem Solving
Tools & Technologies
Microsoft WordExcelTeams MessagingVPN AccessEHR Portals
Certifications & Qualifications
High School DiplomaG.E.D
Industry Keywords
Regulatory ComplianceHIPAA GuidelinesMedical Management ServicesRisk ManagementClaims 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 the confidentiality of member information
- 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, including attention to customers, sensitivity to issues, and proactive identification and resolution of issues
- 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
- Experience with multiple monitors and multiple applications
- Ability to use 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
- Openness to learning new skills as the workplace environment evolves
- 2–4 years of experience as a medical assistant, office assistant, or claim processor (preferred)
- Familiarity with CEC/GPS or MedCompass (preferred)
- 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 including keyboard, monitor, computer, and headset