Senior Pharmacy Claims & Benefit Specialist

CVS Health; Florida; 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 seeking a detail-oriented Claims Processor to research, review and correct pharmacy-related claim issues, ensuring accurate benefits administration and regulatory compliance. The role requires strong analytical skills, the ability to work independently, and to meet productivity and quality expectations.

Responsibilities include processing routine and non-routine tasks, following protocols, reviewing claims, identifying overpayments/underpayments, and adapting to business needs.

Qualifications

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

Responsibilities

• Executes routine and non-routine business support tasks for the Claim Benefit area under limited supervision.
• Follows area protocols to provide effective and timely support.
• Reviews pre-specified claims or claims beyond specialist adjudication authority.
• Identifies and reports claim overpayments, underpayments, and irregularities.
• Takes direction to execute techniques and responsibilities.

Skills

Pharmacy claims processing

Analytical skills

Attention to detail

Communication skills

Data interpretation

Education

Associate degree or equivalent experience

Tools

DG system

Job description

CVS Health is seeking a detail-oriented Claims Processor to research, review and correct pharmacy-related claim issues, ensuring accurate benefits administration and regulatory compliance. The role requires strong analytical skills, the ability to work independently, and to meet productivity and quality expectations.

Responsibilities include processing routine and non-routine tasks, following protocols, reviewing claims, identifying overpayments/underpayments, and adapting to business needs.