Senior Pharmacy Claims Benefit Analyst

CVS Health; South Carolina; Hybrid; 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

Bonus eligibility

Job summary

CVS Health is hiring for a full-time claims processing role in the United States, focused on researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration and regulatory compliance. The position requires strong analytical skills and attention to detail.

With 40 hours weekly, the role offers a comprehensive benefits package including medical, dental, and vision coverage, paid time off, and retirement options.

Qualifications

• 2+ years of production environment experience.
• 2+ years of medical claim 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

Production environment experience

Medical claim processing

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health is hiring for a full-time claims processing role in the United States, focused on researching, reviewing, and correcting pharmacy-related claim issues to ensure accurate benefit administration and regulatory compliance. The position requires strong analytical skills and attention to detail.

With 40 hours weekly, the role offers a comprehensive benefits package including medical, dental, and vision coverage, paid time off, and retirement options.