Description

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

The Medical Claim Analyst is responsible for the initial review, assessment, and triage of assigned claims. This role determines coverage, verifies member eligibility, identifies and redirects misrouted requests, and prepares authorizations within designated systems for clinical review.

The position requires strong organizational skills and the ability to prioritize work effectively to meet regulatory requirements and established claim turnaround times. The Claims Review Coordinator serves as a key liaison between internal teams, healthcare providers, and external stakeholders to support effective medical management services and positive member outcomes.

Additional responsibilities include conducting non-clinical research, maintaining accurate and complete documentation, assisting with claims payment issue resolution, and ensuring compliance with company policies, regulatory standards, accreditation requirements, and confidentiality guidelines.

Key Responsibilities

• Conduct initial review and triage of assigned claims and authorization requests.
• Verify member eligibility and benefits coverage.
• Identify and redirect misrouted claims or requests to the appropriate department.
• Prepare and process authorizations for clinical review by medical staff.
• Prioritize workload to meet regulatory requirements and turnaround time standards.
• Collaborate with internal and external stakeholders to support medical management activities.
• Perform non-clinical research and administrative support functions.
• Maintain accurate, complete, and timely documentation in accordance with company, regulatory, and accreditation standards.
• Protect the confidentiality of member information and comply with all privacy and security policies.
• Investigate and assist in resolving claims payment issues.
• Support continuous improvement of service quality and member experience.

Required Qualifications

• Excellent organizational, time management, and prioritization abilities.
• Basic knowledge of medical terminology and healthcare concepts.
• Proficiency with Microsoft Office applications, including Excel and Word.
• Ability to navigate multiple internal and external computer systems efficiently.
• Understanding of:
  • Benefits administration and management
  • Claims processing and payment management
  • Claims policies and procedures
  • General business operations
  • Clinical and medical management concepts
  • Critical thinking and sound decision-making skills

Preferred Qualifications

• 2 to 4 years of experience in one or more of the following:
  • Medical assistant role
  • Medical office administration
  • Healthcare claims processing
  • Utilization management or authorization support
• Experience using healthcare systems such as:
  • CEC
  • HRP
  • Rumba
  • MedCompass

Education

• High School Diploma or GED required.

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$18.50 - $31.72

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.

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.