Senior Pharmacy Claims & Benefit Specialist

CVS Health; Illinois; Ibrido; USD 25.000 - 53.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical benefits

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Descrizione del lavoro

CVS Health in the United States seeks a Claim Benefits Analyst to research, review, and correct pharmacy-related claim issues ensuring accurate benefit administration and regulatory compliance.

You will execute routine tasks, follow established protocols, review complex claims, and identify overpayments or underpayments while working with reports and data, maintaining accuracy and efficiency.

Competenze

• 2+ years experience in a production environment.
• 2+ years medical claim processing experience.
• Associate degree or equivalent 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.

Mansioni

• 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.
• Identifies and reports claim overpayments, underpayments, and irregularities.
• Takes direction to execute techniques, processes, and responsibilities.

Conoscenze

Attention to detail

Analytical thinking

Problem solving

Communication skills

Multitasking

Independence

Formazione

Associate degree or equivalent experience

Strumenti

DG system claims processing

Descrizione del lavoro

CVS Health in the United States seeks a Claim Benefits Analyst to research, review, and correct pharmacy-related claim issues ensuring accurate benefit administration and regulatory compliance.

You will execute routine tasks, follow established protocols, review complex claims, and identify overpayments or underpayments while working with reports and data, maintaining accuracy and efficiency.