Senior Pharmacy Claim Benefit Analyst

CVS Health; Washington; On-site; 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, financial accuracy, and regulatory compliance. The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

You will execute routine and non-routine business support tasks for the Claim Benefit area under limited supervision, follow area protocols, identify

Qualifications

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

Responsibilities

• Research, review, and correct pharmacy-related claim issues under limited supervision.
• Follow area protocols, standards, and policies to provide effective support.
• Review pre-specified claims or those beyond adjudication authority.
• Identify and report claim overpayments, underpayments, and irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Skills

Analytical skills

Attention to detail

Problem-solving skills

Communication skills

Multitasking

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, financial accuracy, and regulatory compliance. The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations.

You will execute routine and non-routine business support tasks for the Claim Benefit area under limited supervision, follow area protocols, identify