Senior Pharmacy Claims & Benefit Specialist

Colorado Psychiatric; Colorado; In loco; USD 25.000 - 53.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Descrizione del lavoro

CVS Health in Colorado is seeking a Claims Processor to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and compliance. The role requires strong analytical skills and the ability to work independently while meeting quality and productivity targets.

The position handles routine and non-routine tasks within the Claim Benefit area, identifying irregularities, and following established protocols to provide timely support.

Competenze

• 2+ years 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.

Mansioni

• Research, review, and correct pharmacy-related claim issues.
• Execute routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• Follow area protocols, standards, and policies to provide effective and timely support.
• Review pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
• Identify and report claim overpayments, underpayments, and any other irregularities.
• Take direction to execute techniques, processes, and responsibilities.

Conoscenze

Production experience

Medical claim processing

Pharmacy claims knowledge

Attention to detail

Analytical skills

Data interpretation

Communication skills

Multi-tasking

DG system claims processing

Formazione

Associate degree or equivalent experience

Strumenti

DG system

Descrizione del lavoro

CVS Health in Colorado is seeking a Claims Processor to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and compliance. The role requires strong analytical skills and the ability to work independently while meeting quality and productivity targets.

The position handles routine and non-routine tasks within the Claim Benefit area, identifying irregularities, and following established protocols to provide timely support.