CVS Health Hiring for Medical Claim Analyst at North Dakota Full Time

CCR is responsible for post-service claim review to determine if specific services can be reimbursed to providers and members.

The analyst role is integral to the CCR team. They start the CCR process with claim submission with a complete review of the claim and claim history. They compile all system information, claim history, plan information, and any additional research required by the workflow, including any legal and regulatory requirements for clinical review.

Collaborate with Medical Directors as required.

Review provider and member claims to determine if they meet CCR review requirements.

Follow applicable workflows, templates, and legal and compliance requirements to provide a complete picture of what required review for the clinicians and Medical Directors.

Organizes and prioritizes work to help meet regulatory and CCR turn around times.

Works with all appropriate internal and external departments to accurately review specified claims and/or clarify any issues found in the course of the review.

Maintains and utilizes all resource materials and systems to effectively manage job responsibilities.

Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
High School Diploma or G.E.D.

Preferred Qualifications
2+ years of claim processing experience and demonstrated ability to handle multiple assignments competently, accurately, and efficiently.

Customer service experience preferred

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

Effective communication, telephonic and organization skills.

Strong customer service skills.

Ability to effectively participate in a multi-disciplinary team

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

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.