Senior Pharmacy Claims Analyst

CVS Health; Mississippi; Hybrid; USD 26,000 - 54,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Paid time off

Wellness programs

Job summary

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

Typical duties include processing routine and non-routine tasks, following established protocols, reviewing claims, identifying discrepancies, and reporting

Qualifications

• 2+ years of medical claim processing experience.
• Experience in a production environment.
• Strong analytical and problem-solving skills.
• Attention to detail and accuracy.
• Ability to interpret data from reports and spreadsheets.
• Effective written and verbal communication skills.
• DG system claims 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 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

Medical claim processing

Production environment experience

Attention to detail

Communication skills

Education

Associate degree or equivalent experience

Job description

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

Typical duties include processing routine and non-routine tasks, following established protocols, reviewing claims, identifying discrepancies, and reporting