Medical Claim Analyst

CVS Health • Oregon, Oregon • 3w ago

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

-Responsible for initial review and triage of claims tasked for review. -Determines coverage, verifies eligibility, identifies and redirects misdirects -Responsible for prepping the authorization in the system and triage cases to medical staff for review. -Organized and prioritizes work to meet regulatory and claim turn-around times -Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team. -Performs non-medical research and support -Adheres to Compliance with PM Policies and Regulatory Standards. -Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. -Protects the confidentiality of member information and adheres to company policies regarding confidentiality. -Assist in the research and resolution of claims payment issue

Required Qualifications

Effective communication, telephonic and organization skills.

Familiarity with basic medical terminology and concepts used in care .

Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.

Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word

Preferred Qualifications

-2-4 years experience as a medical assistant, office assistant or claim processor

-CEC/GPS, or MedCompass

Education

High School Diploma or G.E.D

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 09/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

Similar Jobs

Virginia Pharmacist-in-Charge (PIC)- Multi- State Sterile Compounding

MDExam • Virginia, Virginia • 12min ago

Hospital & Medical

MD Exam Is Expanding | Virginia Pharmacist in Charge (PIC) MD Exam is seeking a licensed pharmacist to serve as the designated Pharmacist in Charge (PIC) supporting established, active multi-state sterile compounding ope...

12min ago

Go to Apply

DRUG TESTING PROGRAM ADMINISTRATIVE ASSISTANT

Air Force District of Washington • Virginia, Virginia • 21h ago

Hospital & Medical

Summary Click on "Learn more about this agency" button below to view Eligibilities being considered and other IMPORTANT information. The primary purpose of this position is to administer all aspects of the installation a...

21h ago

Go to Apply

Senior Manager Medical Staff Services

Kadlec • Oregon, Oregon • 22h ago

Hospital & Medical

Description Providence is calling for Senior Manager Medical Staff Services - Medical Staff Services - Full time, Day, Hybrid Relocation assistance available for eligible candidates. Reporting directly to the Executive D...

22h ago

Go to Apply

Senior Manager Medical Staff Services

Kadlec • California, California • 22h ago

Hospital & Medical

22h ago

Go to Apply

PHYSICIAN (MEDICAL EVALUATION BOARD)

Naval Medical Command • California, California • 1d ago

Hospital & Medical

Summary This is a public notice flyer to notify interested applicants of anticipated vacancies. Applications will not be accepted through this flyer. Interested applicants must follow the directions in the "How to Apply"...

1d ago

Go to Apply

Nurse (Substance Use Disorder)

Insight Global • Michigan, Michigan • 2d ago

Hospital & Medical

Job Description Insight Global is seeking an RN or LPN to join our client in Gaylord, MI within a Substance Use Disorder Clinic. In this role, you will be the initial point of contact for patients seeking assisted recove...

2d ago

Go to Apply

ENGINEERING TECHNICIAN (ELECTRICAL)

Naval Special Warfare Command • Virginia, Virginia • 3d ago

Hospital & Medical

3d ago

Go to Apply

Respiratory Therapist II - PER_DIEM - 12 Hour Nights

Cedars-Sinai • California, California • 4d ago

Hospital & Medical

Job Description Every Skill. Every Effort. Everything We Have When the work you do every single day has a crucial impact on the lives of others, every effort, every detail, and every second matters. This shared culture o...

4d ago

Go to Apply

In-Home Nurse Practitioner or Physician Assistant (Per Diem) - San Francisco, CA

CVS Health • California, California • 4d ago

Hospital & Medical

4d ago

Go to Apply

Registered Nurse - Care Coordinator - 8 Hour Day **5K SIGN ON BONUS*

Cedars-Sinai • California, California • 4d ago

Hospital & Medical

Job Description The Case Manager Care Coordinator coordinates the care and service of patient populations from admission through discharge. The Care Coordinator clinically assesses, plans, implements, coordinates, monito...

4d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)