Senior Pharmacy Claims & Benefit Specialist

CVS Health; Kentucky; On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement benefits

Job summary

CVS Health is seeking a detail-oriented claims analyst to research, review, and correct pharmacy-related claim issues ensuring accurate benefit administration and regulatory compliance. You will handle routine and select non-routine tasks, identify discrepancies, and follow established protocols for timely support.

The role emphasizes strong analytical ability, attention to detail, and the capacity to work independently while maintaining productivity and quality within a full-time schedule.

Qualifications

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

Responsibilities

• Research, review, and correct pharmacy-related claim issues to ensure accurate benefit administration.
• Execute routine and non-routine tasks under limited supervision with adherence to policies.
• Identify and report claim overpayments, underpayments, and irregularities.
• Follow area protocols and provide timely support.
• Process claims beyond adjudication authority as needed.

Skills

Claim processing

Analytical skills

Attention to detail

Communication skills

Education

Associate degree

Tools

DG system

Job description

CVS Health is seeking a detail-oriented claims analyst to research, review, and correct pharmacy-related claim issues ensuring accurate benefit administration and regulatory compliance. You will handle routine and select non-routine tasks, identify discrepancies, and follow established protocols for timely support.

The role emphasizes strong analytical ability, attention to detail, and the capacity to work independently while maintaining productivity and quality within a full-time schedule.