Medical Claims Analyst

Overview

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.

A Brief Overview Supports cost management programs to reduce medical claim expense and identify and recover medical claim expense dollars from liable parties. Gathers data and compiles cost analyses to identify cost-saving opportunities and cost reduction strategies to achieve financial goals.

• Performs reviews and processing of claims to insurance carriers for payment to ensure accurate and timely claim submissions, helping patients receive the care they deserve.
• Maintains, enters, and organizes all claims reporting, communications, and discovery on claims in the claims drive or a claims administrative system to ensure industry-proven best practices are instilled within the company's strategies and end product offerings.
• Conducts analysis and conflict resolution to identify any errors or inconsistencies on initial claims submissions, ensuring claims are error-free and promptly resolved.
• Handles correspondence, claims, and referrals in the established time frames and performance guarantees to ensure a high level of customer satisfaction and loyalty.
• Drafts first notice of claims, preservation of evidence letters, and email holds for litigation holds.
• Provides communication to and from Operations and other support departments for escalation of service-impacting issues.
• Prepares presentations and proposals to internal and external clients to successfully enhance the company's brand recognition and competitive advantage in the industry.
• Evaluates methods/processes after listening to customers and gathering feedback to proactively address and resolve customer service requests and issues.
• Presents status updates, issues and risks, and solutions to senior management, stakeholders, and partners to drive decision-making and actions.

• 2-5 years work experience
• Adept at problem solving and decision making skills

Promptly review, analyze and provide accurate claim information in order to optimize savings on appropriate claims. Review claims and apply the correct pricing to the claim review. Apply the appropriate contractual and plan benefits to claims reviewed. Determines coverage, verifies eligibility, order of benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring correct claim adjudication.

Required Qualifications
2+ years claim ACAS Medical claim processing experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.

Preferred Qualifications
Excel experience

High School Diploma or G.E.D.

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.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• 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.

For more information, visit

We anticipate the application window for this opening will close on: 02/18/2026

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