Remote Medical Claim Analyst – Healthcare Cost Optimization Specialist for CVS Health (Work‑From‑Home)

Why Join CVS Health? Your Mission, Our Purpose

At CVS Health, we live by a single, powerful purpose: Bringing our heart to every moment of your health. This purpose fuels a culture where compassion meets innovation, and every employee is empowered to transform the way health care is delivered. As a leader in retail pharmacy, pharmacy‑benefit management, and health services, CVS Health reaches millions of Americans daily, providing convenient, affordable, and personalized care. Joining our team means becoming part of a vibrant community that values human‑centric solutions, continuous learning, and a commitment to the well‑being of both our customers and our colleagues.

Position Overview – Remote Medical Claim Analyst

We are seeking a seasoned Remote Medical Claim Analyst to join our dynamic Medical Claims team. In this role, you will be a critical link between providers, customers, and internal stakeholders, ensuring that every claim is processed accurately, efficiently, and in alignment with our cost‑optimization strategies. Your analytical expertise will drive savings opportunities, enhance compliance, and uphold the highest standards of customer service—all from the comfort of your home office.

Key Responsibilities

• Claim Review & Validation: Examine medical claim submissions for accuracy, completeness, and compliance with CVS Health policies, identifying any discrepancies or anomalies.
• Cost‑Optimization Analysis: Detect trends in provider billing practices, recommend corrective actions, and support initiatives that reduce unnecessary spend while preserving quality of care.
• Customer Interaction: Respond promptly to customer inquiries regarding benefits, claim status, and coverage details, maintaining a courteous and solution‑focused demeanor.
• Policy Administration: Uphold and continuously improve policies and procedures related to medical cost management, ensuring alignment with regulatory requirements.
• Adjudication Coordination: Partner with internal claim adjudication teams to streamline workflows, resolve escalations, and guarantee timely claim settlements.
• Training & Development: Design and deliver training modules on billing appropriateness and health‑plan guidelines for claim processors and newly onboarded staff.
• Automation & Testing: Conduct testing of automated code‑review tools, provide feedback for enhancements, and help integrate intelligent solutions into everyday processes.
• Reporting & Documentation: Generate detailed reports on claim trends, cost‑saving outcomes, and performance metrics for senior leadership review.
• Compliance Monitoring: Stay current with federal and state health‑care regulations, ensuring that all claim handling practices adhere to legal standards.

Essential Qualifications – What You Bring to the Table

• Experience: Minimum of 5 years of professional experience in medical claim analysis, health‑plan operations, or a related field within the health‑care industry.
• Education: High school diploma or equivalent is required; additional coursework or certifications in health‑care administration, medical billing, or data analytics is highly preferred.
• Analytical Acumen: Proven ability to interpret complex claim data, identify trends, and recommend actionable solutions that drive cost efficiencies.
• Problem‑Solving Skills: Demonstrated experience using structured decision‑making frameworks to resolve ambiguous or high‑impact issues.
• Communication Excellence: Strong written and verbal communication skills, with the capacity to convey technical information clearly to non‑technical audiences.
• Technology Proficiency: Comfortable using claim‑management platforms, Microsoft Office Suite (especially Excel), and basic SQL or data‑visualization tools.
• Customer‑Service Orientation: A genuine desire to help customers understand their benefits and resolve concerns efficiently.
• Reliability & Self‑Discipline: Ability to thrive in a remote work environment, manage time effectively, and meet deadlines without direct supervision.

Preferred Qualifications – The Extra Edge

• Associate’s or Bachelor’s degree in Health‑Care Administration, Business, Finance, or a related discipline.
• Professional certification such as Certified Patient Account Specialist (CPAS), Certified Professional Biller (CPB), or Certified Health Insurance Specialist (CHIS).
• Hands‑on experience with automated claim‑review technologies, robotic process automation (RPA), or machine‑learning driven analytics.
• Familiarity with CMS guidelines, Medicare/Medicaid regulations, and private payer contracts.
• Experience delivering virtual training sessions or creating e‑learning content for adult learners.

Core Skills & Competencies for Success

• Detail Orientation: Ability to spot even the smallest inconsistencies in claim data.
• Critical Thinking: Evaluate multiple sources of information to make informed decisions.
• Collaboration: Work seamlessly with cross‑functional teams, including finance, compliance, and IT.
• Adaptability: Remain agile in a fast‑changing health‑care environment and embrace new technologies.
• Ethical Judgment: Uphold the highest standards of confidentiality and integrity when handling sensitive health information.
• Time Management: Prioritize tasks effectively to meet service‑level agreements and project deadlines.

Career Growth & Learning Opportunities

CVS Health invests heavily in the professional development of its employees. As a Remote Medical Claim Analyst, you will have access to a rich ecosystem of learning resources:

• Internal Learning Portal: Unlimited access to self‑paced courses covering topics like advanced analytics, health policy, and leadership development.
• Mentorship Programs: Pairing with seasoned senior analysts to accelerate skill acquisition and career planning.
• Cross‑Functional Projects: Opportunities to contribute to initiatives beyond claim analysis, such as fraud detection, population health management, and digital transformation.
• Career Pathways: Clear progression routes toward senior analyst, team lead, manager, and director roles within the broader health‑care operations umbrella.

Work Environment & Company Culture

Our remote workforce is supported by a collaborative, inclusive, and technology‑enabled environment:

• Flexible Scheduling: Choose a work schedule that aligns with your personal commitments while meeting core business hours.
• Virtual Community: Regular team huddles, virtual coffee chats, and online forums foster connection among distributed employees.
• Diversity & Inclusion: CVS Health is committed to building a workforce that reflects the diverse communities we serve.
• Well‑Being Programs: Access to mental‑health resources, wellness challenges, and ergonomic support for home office setups.
• Recognition & Rewards: Employee recognition platforms celebrate achievements, and performance‑based incentives acknowledge exceptional contributions.

Compensation, Perks, & Benefits

We offer a competitive total rewards package designed to attract and retain top talent:

• Base Salary: Ranges from $18.50 to $31.72 per hour (or equivalent annual salary), calibrated based on experience, education, and geographic considerations.
• Performance Incentives: Eligibility for CVS Health bonus, commission, or short‑term incentive programs.
• Health Benefits: Comprehensive medical, dental, and vision coverage for you and eligible dependents.
• Retirement Savings: 401(k) plan with company match, plus an Employee Stock Purchase Plan (ESPP) offering the chance to invest in CVS Health’s future.
• Insurance Coverage: Fully‑paid term life insurance, short‑term and long‑term disability protection.
• Paid Time Off: Generous PTO accrual, paid holidays, and sick leave in accordance with state laws and company policy.
• Well‑Being Perks: Access to wellness programs, employee assistance services, educational assistance, free development courses, CVS store discounts, and partner‑program discounts.

How to Apply – Take the Next Step

If you are passionate about improving health‑care outcomes, thrive in a data‑driven environment, and want a flexible, remote role with a purpose‑filled organization, we want to hear from you. We value attitude, curiosity, and a willingness to learn just as much as experience. Your journey toward making a tangible impact on millions of lives begins with a single click.

Ready to Join the Heart‑Centered Team?

Submit your application today and become a vital part of CVS Health’s mission to bring our heart to every moment of health. We look forward to welcoming a dedicated professional who will help shape the future of medical claim analysis.

Apply Now – Start Your CVS Health Career