Senior Pharmacy Claims & Benefit Analyst

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

Job summary

CVS Health is seeking a detail-oriented professional to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. You will work independently, analyze data, and resolve discrepancies to support high-quality patient care.

The role requires strong analytical skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. Full-time, on-site, with a comprehensive benefits package.

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.

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

Analytical skills

Attention to detail

Communication skills

Data interpretation

Independent worker

DG system experience

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is seeking a detail-oriented professional to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and regulatory compliance. You will work independently, analyze data, and resolve discrepancies to support high-quality patient care.

The role requires strong analytical skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. Full-time, on-site, with a comprehensive benefits package.