Senior Pharmacy Claims & Benefit Specialist

Florida Pharmacy Association, Inc.; Florida; On-site; 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 in Florida is seeking a claims processor to research, review, and correct 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 while meeting productivity targets.

You will execute routine and non-routine tasks, follow procedures, identify overpayments or underpayments, and support the Benefit area under supervision.

Qualifications

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

Responsibilities

• Executes both 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

Analytical skills

Attention to detail

Communication skills

Independent work

Education

Associate degree or equivalent experience

Tools

DG system claims processing

Job description

CVS Health in Florida is seeking a claims processor to research, review, and correct 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 while meeting productivity targets.

You will execute routine and non-routine tasks, follow procedures, identify overpayments or underpayments, and support the Benefit area under supervision.