Senior Pharmacy Claims & Benefit Specialist

CVS Health; Indiana; Hybride; USD 25 000 - 53 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Bonus eligibility

Résumé du poste

CVS Health is seeking a detail-oriented Claims Analyst to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and compliance. You will handle routine and non-routine tasks with limited supervision, review complex claims, and identify overpayments or irregularities to support efficient processing.

The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality

Qualifications

• 2+ years experience in a production environment.
• 2+ years medical claim processing experience.
• Attention to detail and accuracy.
• Strong analytical and problem-solving skills.
• Effective written and verbal communication skills.
• Ability to interpret data from reports and spreadsheets.
• Ability to manage multiple priorities and work independently.

Responsabilités

• Executes both routine and non-routine business support tasks for the Claim Benefit area under limited supervision, referring deviations from standard practices to managers.
• 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.

Description du poste

CVS Health is seeking a detail-oriented Claims Analyst to research, review, and correct pharmacy-related claim issues, ensuring accurate benefit administration and compliance. You will handle routine and non-routine tasks with limited supervision, review complex claims, and identify overpayments or irregularities to support efficient processing.

The role requires strong analytical skills, attention to detail, and the ability to work independently while meeting productivity and quality