$18.50 - $38.82/hr
Medical
Dental
Vision
Retirement
PTO
Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and ...
New
$18.50 - $38.82/hr
Medical
Dental
Vision
Retirement
PTO
Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and ...
New
Dallas, TX · Remote
$18 - $32/hr
Retirement
A Medical Claims Analyst (MCA) i s responsible for the intake processing and triage of all initial claim documents in a high-volume environment. This includes but is not limited to referral ...
Dallas, TX · Remote
$18 - $32/hr
Retirement
A Medical Claims Analyst (MCA) i s responsible for the intake processing and triage of all initial claim documents in a high-volume environment. This includes but is not limited to referral ...
Plano, TX · On-site
$18.50 - $21/hr
Medical
Dental
Vision
Life
Retirement
THIS IS NOT A REMOTE POSITION The Reny Company's medical claim processor is a professional who combines experience in health insurance and medical billing with business insight and a passion for ...
Quick apply
Plano, TX · On-site
$18.50 - $21/hr
Medical
Dental
Vision
Life
Retirement
THIS IS NOT A REMOTE POSITION The Reny Company's medical claim processor is a professional who combines experience in health insurance and medical billing with business insight and a passion for ...
* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...
Quick apply
* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...
Miami, FL · On-site
* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...
Quick apply
Miami, FL · On-site
* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...
Pensacola, FL · On-site
$17.75 - $23.75/hr
Medical
Dental
Vision
Life
Retirement
PTO
This position will be directly involved in analyzing pre-bill claim edits, claim denials, and AR ... The Medical Coder will be directly involved in claims denial management, working alongside the ...
Pensacola, FL · On-site
$17.75 - $23.75/hr
Medical
Dental
Vision
Life
Retirement
PTO
This position will be directly involved in analyzing pre-bill claim edits, claim denials, and AR ... The Medical Coder will be directly involved in claims denial management, working alongside the ...
$17 - $28.46/hr
Medical
Dental
Vision
Retirement
PTO
Medical Claim processing experience preferably supporting Medicare products. * Strong computer navigational skills. * Medical terminology and coding certification. Note: Our CBS positions in Medicare ...
$17 - $28.46/hr
Medical
Dental
Vision
Retirement
PTO
Medical Claim processing experience preferably supporting Medicare products. * Strong computer navigational skills. * Medical terminology and coding certification. Note: Our CBS positions in Medicare ...
$15.75 - $20.25/hr
Medical Biller Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant ... Analyzes claim edits within billing system and payer sites with a variety of different issues, such ...
$15.75 - $20.25/hr
Medical Biller Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant ... Analyzes claim edits within billing system and payer sites with a variety of different issues, such ...
Knoxville, TN · On-site
$15.75 - $20.25/hr
Overview Medical Biller Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview ... Analyzes claim edits within billing system and payer sites with a variety of different issues, such ...
Knoxville, TN · On-site
$15.75 - $20.25/hr
Overview Medical Biller Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview ... Analyzes claim edits within billing system and payer sites with a variety of different issues, such ...
OR · On-site +1
This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to ...
OR · On-site +1
This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to ...
$18.50 - $42.35/hr
Medical
Dental
Vision
Retirement
PTO
Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in ... Required Qualifications - Minimum of 18 months of medical claim processing experience with a health ...
$18.50 - $42.35/hr
Medical
Dental
Vision
Retirement
PTO
Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in ... Required Qualifications - Minimum of 18 months of medical claim processing experience with a health ...
New York, NY · Remote
$18.50 - $42.35/hr
Medical
Dental
Vision
Retirement
PTO
Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in ... Required Qualifications - Minimum of 18 months of medical claim processing experience with a health ...
New York, NY · Remote
$18.50 - $42.35/hr
Medical
Dental
Vision
Retirement
PTO
Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in ... Required Qualifications - Minimum of 18 months of medical claim processing experience with a health ...
Minneapolis, MN · On-site
$52K - $62K/yr
Validate claim information to ensure completeness and accuracy; address any discrepancies or missing data. * Pay, pend, or deny claims based on eligibility, precertification, COB, medical review, and ...
New
Minneapolis, MN · On-site
$52K - $62K/yr
Validate claim information to ensure completeness and accuracy; address any discrepancies or missing data. * Pay, pend, or deny claims based on eligibility, precertification, COB, medical review, and ...
New
Homer, AK · Remote
$18.50 - $42.35/hr
Medical
Dental
Vision
Retirement
PTO
Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in ... Required Qualifications - Minimum of 18 months of medical claim processing experience with a health ...
Homer, AK · Remote
$18.50 - $42.35/hr
Medical
Dental
Vision
Retirement
PTO
Position Summary Reviews and adjudicates complex, sensitive, and specialized medical claims in ... Required Qualifications - Minimum of 18 months of medical claim processing experience with a health ...
Medical
Dental
Vision
Life
Retirement
PTO
High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability to work in a fast-paced, customer centric & production driven environment * Excellent verbal and ...
Medical
Dental
Vision
Life
Retirement
PTO
High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability to work in a fast-paced, customer centric & production driven environment * Excellent verbal and ...
Medical
Dental
Vision
Life
Retirement
PTO
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement. * Provide clear, well-documented rationales for service approvals or denials. * Educate internal and ...
Medical
Dental
Vision
Life
Retirement
PTO
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement. * Provide clear, well-documented rationales for service approvals or denials. * Educate internal and ...
New York, NY · On-site
$20.75 - $26/hr
Processing of Medical Claim Forms (HCFA, UB04)Knowledge of Medical Terminology Knowledge of HIPPA Guidelines regarding Protected Health Information Data Entry of Provider Claim/Billing information ...
Quick apply
New York, NY · On-site
$20.75 - $26/hr
Processing of Medical Claim Forms (HCFA, UB04)Knowledge of Medical Terminology Knowledge of HIPPA Guidelines regarding Protected Health Information Data Entry of Provider Claim/Billing information ...
Be Seen First
Phoenix, AZ · On-site
$22 - $28/hr
Dental
Vision
Life
Retirement
PTO
Qualified candidates should have previous experience in medical claim billing, insurance follow-up, and have knowledge of AHCCCS guidelines. In addition, qualified candidates must have a stable work ...
Quick apply
Be Seen First
Phoenix, AZ · On-site
$22 - $28/hr
Dental
Vision
Life
Retirement
PTO
Qualified candidates should have previous experience in medical claim billing, insurance follow-up, and have knowledge of AHCCCS guidelines. In addition, qualified candidates must have a stable work ...
$18.07 - $33.92/hr
Medical
Dental
Vision
Life
Retirement
PTO
High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability to work in a fast-paced, customer centric & production driven environment * Excellent verbal and ...
$18.07 - $33.92/hr
Medical
Dental
Vision
Life
Retirement
PTO
High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability to work in a fast-paced, customer centric & production driven environment * Excellent verbal and ...
Lombard, IL · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability to work in a fast-paced, customer centric & production driven environment * Excellent verbal and ...
Lombard, IL · On-site +1
Medical
Dental
Vision
Life
Retirement
PTO
High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability to work in a fast-paced, customer centric & production driven environment * Excellent verbal and ...
$5.29 - $6.51
0% of jobs
$6.51 - $7.74
0% of jobs
$7.74 - $8.96
0% of jobs
$8.96 - $10.18
0% of jobs
$10.18 - $11.41
0% of jobs
$11.41 - $12.63
0% of jobs
$12.63 - $13.85
0% of jobs
$13.85 - $15.08
11% of jobs
$15.46 is the 25th percentile. Wages below this are outliers.
$15.08 - $16.30
44% of jobs
$16.30 - $17.53
0% of jobs
$18.06 is the 75th percentile. Wages above this are outliers.
$17.53 - $18.75
44% of jobs
$5
$16
$18
Cities with the most Medical Claim job openings:
States with the most job openings for Medical Claim jobs include:
$18.50 - $38.82/hr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 3 days ago
New
5.8
Based on 4,338 frontline employees who took The Breakroom Quiz
89th of 112 rated pharmacies
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 ourselvesaccountable 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
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 the claim submission to CCR with a complete
review of the claim and claim history. They compile all system information,
claim history, plan information, and any additional research into template as
required by the workflow and any legal and regulatory requirements for a
clinician review.
-They also 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 is requiring review to the CCR clinicians and medical directors.
-Organizes and prioritizes work to help meet regulatory and CCR claim turnaround times. Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and legal requirements.
-Works with all appropriate internal and external departments and personnel to accurately review specified claims and/or clarify any issues found in the course of the review.
-Required to work in multiple systems including EWM, ASD, ATV, MedCompass and HRP.
-Other systems dependent on specific reviews criteria.
-Maintains and utilizes all resource materials and systems to effectively manage job responsibilities
Adheres to company policies to protect member
confidentiality.
Required Qualifications
2+ years experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Preferred Qualifications
Knowledge of utilization management rules and regulations and claim processing guidelines.
Claims Processing/ customer service experience preferred
Education Verifiable High School Diploma or GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $38.82This 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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
