Senior Claim Benefit Specialist - Pharmacy (RX)

CVS Health; New Jersey; Hybride; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Medical coverage

Retirement benefits

Résumé du poste

CVS Health in New Jersey seeks a claims processor to research, review and correct pharmacy-related claim issues, ensuring accurate benefits and regulatory compliance. You’ll handle routine and complex tasks, follow protocols, and report irregularities with attention to detail and analytical rigor.

The role requires 2+ years in medical claim processing, a state of health industry knowledge, and the ability to work independently in a fast-paced environment.

Qualifications

• 2+ years in a production environment.
• 2+ years medical claim processing experience.
• Knowledge of pharmacy claims, benefits and adjustments.
• Attention to detail and accuracy.
• Strong analytical and problem-solving skills.
• Ability to interpret data from reports and spreadsheets.
• Effective written and verbal communication skills.
• Ability to manage multiple priorities and work independently.
• DG system claims processing experience.

Responsabilités

• Investigates and corrects pharmacy-related claim issues to ensure accurate benefit administration.
• Executes routine and non-routine tasks for the Claim Benefit area under supervision.
• Follows area protocols to provide effective and timely support.
• Reviews pre-specified claims or those beyond adjudication authority.
• Identifies and reports claim overpayments, underpayments and irregularities.

Connaissances

Analytical thinking

Attention to detail

Problem-solving

Communication skills

Independent work

Formation

Associate degree or equivalent

Outils

DG system claims processing

Description du poste

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

Responsible for researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration, financial accuracy, and compliance with client and regulatory requirements. The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

• Executes both routine and non-routine business support tasks for the Claim Benefit area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
• Identifies and reports claim overpayments, underpayments, and any other irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Required Qualifications

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

Preferred Qualifications

• Knowledge of pharmacy claims, benefits, and adjustment processes.
• Attention to detail and accuracy.
• Strong analytical and problem-solving skills.
• Ability to interpret data from reports and spreadsheets.
• Effective written and verbal communication skills.
• Ability to manage multiple priorities and work independently.
• DG system claims processing experience

Education

• Associate degree or equivalent experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

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. 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: 11/24/2026

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