Medical Claim Analyst

Overview

Join CVS Health®, a company dedicated to creating a health-focused world centered on individuals. Our team is passionate, innovative, accountable, and prioritizes safety and quality. Forward your career by helping simplify healthcare for individuals, families, and communities.

Position Summary

The Medical Claim Analyst will serve on the Provider Coding and Reimbursement (PCR) team, focusing on reviewing denial disputes related to provider coding and reimbursement.

Key Responsibilities

• Examine provider resubmissions involving ClaimsXten, Clinical Validation, Prospective Claim Accuracy, Novologix, and DRG claims, resolving them or preparing for clinical review.
• Effectively prioritize and multitask to meet workload demands and deadlines.
• Assess provider rework claims following claim processing and PCR standards.
• Conduct research on claims using ASD or ACAS/EWM software systems.
• Document claim histories within Aetna Strategic Desktop (ASD) and Electronic Correspondence Handling System (ECHS).

Minimum Qualifications

• Capability to review claims accurately.
• Proficiency with Excel spreadsheets as needed.
• Strong communication and teamwork skills within the department.
• Ability to work both independently and collaboratively.
• Effective workload prioritization with multitasking ability.
• Commitment to delivering high-quality service by meeting performance metrics and productivity goals.

Preferred Qualifications

• Familiarity with systems like IFP and HRP for exchange support.
• Experience with rework processing, EWM, ASD, and ECHS systems.
• Highly preferred experience with ACAS/EWM.
• Background in claims processing considered an advantage.
• Proven history of producing quality results and strong claim expertise.
• Analytical aptitude and technical proficiency.
• Comprehensive knowledge of benefit plans, policies, and procedures.
• Demonstrated ability to handle multiple tasks with precision and efficiency.
• Strong attention to detail.

Education

High School diploma, G.E.D., or equivalent experience required.

Work Hours and Pay

This is a full-time role requiring 40 hours per week.

Pay scale ranges from $18.50 to $35.29 per hour, dependent on experience, education, location, and other considerations.

Benefits

This position includes eligibility for a robust benefits package supporting the physical, emotional, and financial well-being of employees and their families. Benefits cover medical, dental, vision plans, paid time off, retirement options, wellness initiatives, and more. Additional details are provided during recruitment and through benefits resources.

Additional Information

Application Deadline: August 15, 2026

Applicants with arrest or conviction records will be evaluated in compliance with applicable federal, state, and local regulations.

CVS Health values a diverse workforce reflecting the communities we serve and is committed to fostering an inclusive environment where all colleagues feel respected and belong.