Senior Pharmacy Claim & Benefit Analyst

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a detail-focused candidate for a Claims Processor role to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role requires strong analytical skills and the ability to work independently while meeting productivity and quality expectations.

Key responsibilities include executing routine and non-routine tasks, following established protocols, reviewing claims, identifying

Qualifications

• 2+ years in a production environment.
• 2+ years medical claim processing experience.
• Strong analytical and problem-solving skills.
• Attention to detail and accuracy.
• Ability to interpret data from reports and spreadsheets.

Responsibilities

• 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.

Skills

Production experience

Medical claims

Analytical skills

Attention to detail

Data interpretation

Verbal communication

Independent work

DG system claims

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a detail-focused candidate for a Claims Processor role to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. The role requires strong analytical skills and the ability to work independently while meeting productivity and quality expectations.

Key responsibilities include executing routine and non-routine tasks, following established protocols, reviewing claims, identifying