Pharmacy Claims Benefit Specialist - Precision & Impact

CVS Health; Arizona; Hybrid; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Claims Analyst to research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration and compliance. The role emphasizes strong analytical skills, attention to detail, and the ability to work independently while meeting productivity targets.

The ideal candidate will have experience in medical claim processing, proficiency with data interpretation, and effective communication to support timely issue resolution.

Qualifications

• 2+ years of experience in a production environment.
• 2+ years medical claim processing experience.

Responsibilities

• Executes routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews pre-specified claims or claims outside specialist adjudication authority.
• Identifies and reports claim overpayments, underpayments, and other irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Attention to detail

Strong analytical and problem-solving

Effective written and verbal沟通 skills

Ability to manage multiple priorities

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a Claims Analyst to research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration and compliance. The role emphasizes strong analytical skills, attention to detail, and the ability to work independently while meeting productivity targets.

The ideal candidate will have experience in medical claim processing, proficiency with data interpretation, and effective communication to support timely issue resolution.