Senior Pharmacy Claims Benefit Analyst

CVS Health; Texas; 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

Job summary

CVS Health is seeking a claims analyst to research, review, and resolve 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.

You will execute routine and non-routine tasks for the Claim Benefit area, follow established protocols, identify overpayments or underpayments, and report irregularities.

Qualifications

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

Responsibilities

• Research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration.
• Ensure compliance with client and regulatory requirements.
• Handle routine and non-routine business support tasks for the Claim Benefit area.
• Follow area protocols, standards, and policies to provide effective and timely support.
• Identify and report claim overpayments, underpayments, and irregularities.

Skills

Analytical thinking

Attention to detail

Problem solving

Communication

Multitasking

Independent working

Education

Associate degree or equivalent experience

Job description

CVS Health is seeking a claims analyst to research, review, and resolve 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.

You will execute routine and non-routine tasks for the Claim Benefit area, follow established protocols, identify overpayments or underpayments, and report irregularities.