Medical Claim Analyst

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

Inspects and provides accurate claim information to support savings optimization for claims. Responds to customers on benefit inquiries. Maintains customer service standards. Administers policies and procedures for medical cost management. Coordinates support functions for claim adjudication.

• Executes both routine and non-routine business support tasks for the Medical Claims area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.

• Review ECHS report daily for distribution of tasks to appeal nurses
• Reviews provider coding edits routed from non-clinical claims and prepares them for review by an Aetna clinician.
• Using CS Hub guidelines, review, and process predetermination requests to determine review eligibility
• Process CORR tasks to work or reroute as appropriate
• Prioritize work and multitasks to balance projected workload and due dates.

• Working knowledge of problem solving and decision-making skills
• 5+ years of work experience

• High school diploma or equivalent required.

40

Full time

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.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
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• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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We anticipate the application window for this opening will close on: 01/25/2026

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